{"hospital_name": "Memorial Health", "last_updated_on": "2026-03-05", "version": "3.0.0", "pid": "1416690376", "rid": "4862", "location_name": ["Memorial Health"], "hospital_address": ["3401 W Gore Blvd, Lawton, OK 73505"], "type_2_npi": ["1720022379"], "license_information": {"license_number": "2237", "state": "OK"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Becky Holland"}, "standard_charge_information": [{"description": "\"\"Y SET\"\" TUBING", "code_information": [{"code": "A4719", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "#10 HEMOSTATIC SCAPLEL BLADE", "code_information": [{"code": "771010700", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 248.81, "discounted_cash": 311.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#10 SCALPELS", "code_information": [{"code": "771004235", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#2 BIDIRECTIONAL TORQUE WRENCH", "code_information": [{"code": "771027218", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 573.39, "discounted_cash": 716.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#20 GASTROSTOMY TUBE", "code_information": [{"code": "771004283", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 464.79, "discounted_cash": 580.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#3 FIRM GRAY SOFT TOUCH HAND EX", "code_information": [{"code": "771010958", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 171.4, "discounted_cash": 214.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#4 BLOOD PRESSURE CUFF NEONATAL", "code_information": [{"code": "771041639", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 56.2, "discounted_cash": 70.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#5 DBL LUMEN UMB VESSEL CATH", "code_information": [{"code": "771041638", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 512.84, "discounted_cash": 641.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#6 NON CUFFED TRACHEEOSTOMY TUBE", "code_information": [{"code": "771005284", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 272.57, "discounted_cash": 340.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#7 PE ZIPLOOP EXT TOGGLELOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771035433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 924.17, "maximum": 2361.78, "gross_charge": 2567.16, "discounted_cash": 3208.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 949.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 949.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 949.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1925.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1925.37, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2361.78, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 924.17, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1925.37, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "*Inc Bx Skin addtl", "code_information": [{"code": "11107", "type": "CPT"}, {"code": "690011107", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 48.87, "maximum": 3380.5, "gross_charge": 135.77, "discounted_cash": 169.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 89.6, 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charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 101.82, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 124.9, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 48.87, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 101.82, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "*Pnch Bx Skin addtl", "code_information": [{"code": "11105", "type": "CPT"}, {"code": "690011105", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 41.15, "maximum": 3380.5, "gross_charge": 114.33, "discounted_cash": 142.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 75.45, "methodology": 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{"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 85.74, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 105.18, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 41.15, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 85.74, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "*RAPID HIV - CHRG ONLY", "code_information": [{"code": "87449", "type": "CPT"}, {"code": "701101975", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.62, "maximum": 31.08, "gross_charge": 33.79, "discounted_cash": 42.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 22.3, "methodology": "percent of total 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{"description": "*Tang Bx Skin addtl", "code_information": [{"code": "11103", "type": "CPT"}, {"code": "690011103", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 36.01, "maximum": 3380.5, "gross_charge": 100.04, "discounted_cash": 125.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 66.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 66.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 66.02, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2440.37, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3380.5, "methodology": "case rate"}, 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SPARTACORE 300", "code_information": [{"code": "771021416", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 902.63, "discounted_cash": 1128.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": ".014 STANDARD 3CM STRAIGHT", "code_information": [{"code": "771013721", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1090.36, "discounted_cash": 1362.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": ".018 FIBERED PLATINUM COILS", "code_information": [{"code": "771023280", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 741.88, "discounted_cash": 927.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": ".018 HI WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771030646", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 270.11, "maximum": 690.3, 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5534.48, "maximum": 14143.68, "gross_charge": 15373.57, "discounted_cash": 19216.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5688.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5688.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5688.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 11530.17, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 11530.17, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 14143.68, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 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"standard_charge_dollar": 904.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 904.8, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1109.89, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 434.3, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 904.8, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "0 C.V. 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"type": "HCPCS"}, {"code": "771043245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4980.07, "maximum": 12726.85, "gross_charge": 13833.54, "discounted_cash": 17291.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5118.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5118.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5118.4, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 10375.15, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 10375.15, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 12726.85, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4980.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 10375.15, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "014 HI-TOQUE PILOT 150 300", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771024228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 252.41, "maximum": 645.04, "gross_charge": 701.14, "discounted_cash": 876.43, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 525.85, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 525.85, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 645.04, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 252.41, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 525.85, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "014 HI-TORQUE PILOT 150-190", "code_information": [{"code": "771024226", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 927.93, "discounted_cash": 1159.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "014 HI-TORQUE PILOT 50 190", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771024225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 252.41, "maximum": 645.04, "gross_charge": 701.14, "discounted_cash": 876.43, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 525.85, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 525.85, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 645.04, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 252.41, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 525.85, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "014 HI-TORQUE PILOT 50 300", "code_information": [{"code": "771024227", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 927.93, "discounted_cash": 1159.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "018 PLATINUM COILS 2/20/4/4/", "code_information": [{"code": "771027730", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2095.73, "discounted_cash": 2619.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "018 PLATINUM COILS 3/30/6/6", "code_information": [{"code": "771027729", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2095.73, "discounted_cash": 2619.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "018 PLATINUM COILS 4/30/4/7", "code_information": [{"code": "771027728", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2143.36, "discounted_cash": 2679.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "02 CANNULA END TIDAL CO2 25/CS", "code_information": [{"code": "771018742", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 37.2, "discounted_cash": 46.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "0211940 2 INCH ROLL,", "code_information": [{"code": "771012003", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 90.88, "discounted_cash": 113.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "0216448RTHO WOMENS SMALL", "code_information": [{"code": "771016447", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 89.34, "discounted_cash": 111.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "025338 VICRYL 3-0 PS-1", "code_information": [{"code": "771003345", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.23, "discounted_cash": 54.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "027183EUTRAL POSITION HAND SPLINT", "code_information": [{"code": "771007166", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 300.96, "discounted_cash": 376.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1 3/4 OSTOMY BARRIER CERAPLUS", "code_information": [{"code": "771042861", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 78.66, "discounted_cash": 98.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1 ADMN RSV MONOC ANTB IM NJX", "code_information": [{"code": "96381", "type": "CPT"}], "standard_charges": [{"minimum": 27.28, "maximum": 27.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 27.28, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 BOD TEMP >=35.5", "code_information": [{"code": "G9773", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 BODYTEMP >=35.5CW/IN 30MIN", "code_information": [{"code": "4559F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4206", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.25, "maximum": 0.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.25, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 DFR 80 CM", "code_information": [{"code": "771027361", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 951.26, "discounted_cash": 1189.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1 EAST OBSERVATION", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "640010217", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 289.15, "gross_charge": 314.3, "discounted_cash": 392.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 289.15, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 113.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 EAST PRIVATE ROOM & BOARD", "code_information": [{"code": "640010205", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1 EAST SEMI-PRIVATE ROOM & BOARD", "code_information": [{"code": "640010215", "type": "CDM"}, {"code": "120", "type": "RC"}], "standard_charges": [{"gross_charge": 1431.63, "discounted_cash": 1789.54, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1 EM CORE SESSION", "code_information": [{"code": "G9873", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 MED VISIT IN 24MO", "code_information": [{"code": "G9247", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 NORTH - CVCU - OBSERVATION", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "631210187", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 307.63, "gross_charge": 334.39, "discounted_cash": 417.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 220.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 220.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 220.69, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 250.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 250.79, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": 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289.15, "gross_charge": 314.3, "discounted_cash": 392.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 289.15, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 113.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 OR NO CT SINUS W/IN 90D DX", "code_information": [{"code": "G9354", "type": "HCPCS"}], 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billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1\" HEEL & SOLE", "code_information": [{"code": "771010222", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 345.63, "discounted_cash": 432.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1\" TAPERED ELASTIC FINGER SLEEVE", "code_information": [{"code": "771012451", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 53.65, "discounted_cash": 67.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1% HYDROCORTISONE MEDIPADS", "code_information": [{"code": "771012746", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 61.09, "discounted_cash": 76.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1.25 PL RD WR THRD LRG STP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771038555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 206.97, "maximum": 528.93, "gross_charge": 574.93, "discounted_cash": 718.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 212.72, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 212.72, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 212.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 431.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 431.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 528.93, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 206.97, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 431.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1.3 DENSITY EGGCRATE WHEELCHAIR C", "code_information": [{"code": "771001547", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 40.72, "discounted_cash": 50.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1.5 MM DRIVER KIT", "code_information": [{"code": "771041127", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1402.3, "discounted_cash": 1752.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1.6 ULTRA LOW RESISTANCE VOICE PR", "code_information": [{"code": "771013568", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 324.68, "discounted_cash": 405.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1.6MM TI K WIRE 150MM-10PK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771049894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.9, "maximum": 257.85, "gross_charge": 280.28, "discounted_cash": 350.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 103.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 103.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 103.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 210.21, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 210.21, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 257.85, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 100.9, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 210.21, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1.6MODEL CD3231-40QUS FGI UNIFY", "code_information": [{"code": "C1882", "type": "HCPCS"}, {"code": "771039845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 51908.21, "maximum": 132654.32, "gross_charge": 144189.48, "discounted_cash": 180236.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 53350.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 53350.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 53350.1, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 108142.11, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 108142.11, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 132654.32, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 51908.21, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 108142.11, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1.7 RX TURBO ELITE", "code_information": [{"code": "C1714", "type": "HCPCS"}, {"code": "771043248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5534.48, "maximum": 14143.68, "gross_charge": 15373.57, "discounted_cash": 19216.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5688.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5688.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5688.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 11530.17, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 11530.17, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 14143.68, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5534.48, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 11530.17, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1/2 INCH SKIN CLOSURE", "code_information": [{"code": "771001151", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.95, "discounted_cash": 11.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1/4 INCH SKIN CLOSURE", "code_information": [{"code": "771001150", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.95, "discounted_cash": 11.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10 GAUGE BIOPSY", "code_information": [{"code": "771040644", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 814.95, "discounted_cash": 1018.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10 GUAGE HAND DRILL", "code_information": [{"code": "771040166", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 606.28, "discounted_cash": 757.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10 TI CANN FRIN GT400 LFT SILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771038292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2669.62, "maximum": 6822.37, "gross_charge": 7415.62, "discounted_cash": 9269.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2743.77, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2743.77, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2743.77, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 5561.71, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 5561.71, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 6822.37, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2669.62, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 5561.71, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "10-Hydroxycarbazepine", "code_information": [{"code": "80183", "type": "CPT"}, {"code": "7014D6140", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.85, "maximum": 74.37, "gross_charge": 80.84, "discounted_cash": 101.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 53.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 53.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 53.35, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 43.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 43.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 43.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 43.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 60.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 60.63, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 74.37, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 29.1, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 60.63, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "10/11MM TROCAR ETHICON", "code_information": [{"code": "771012269", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 722.35, "discounted_cash": 902.94, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "100 INSULIN SYRINGES", "code_information": [{"code": "S8490", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.6, "maximum": 33.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "10FR AVANTI 20CM", "code_information": [{"code": "771015781", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 165.36, "discounted_cash": 206.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10FR BLAKE DRAIN W/ 1/8DIAMETER", "code_information": [{"code": "771011417", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 501.62, "discounted_cash": 627.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10FR INTRODUCER KIT", "code_information": [{"code": "771009194", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 573.39, "discounted_cash": 716.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10G 15MM DRCT BILAT KYPHOPLAST", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "771038306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2594.88, "maximum": 6631.37, "gross_charge": 7208.02, "discounted_cash": 9010.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2666.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2666.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2666.96, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 5406.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 5406.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 6631.37, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2594.88, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 5406.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "10G BIOPSY ID MARKERS", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771042006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 264.54, "maximum": 676.07, "gross_charge": 734.86, "discounted_cash": 918.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 271.89, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 271.89, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 271.89, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 551.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 551.14, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 676.07, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 264.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 551.14, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "10G BOWTIE IDENTIFER", "code_information": [{"code": "771042119", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3401.81, "discounted_cash": 4252.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10G ELITE PROBE", "code_information": [{"code": "771042201", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1389.64, "discounted_cash": 1737.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10G VERTEPORT CEMENT CANNULA", "code_information": [{"code": "771040164", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 504.98, "discounted_cash": 631.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10L ZCT 300", "code_information": [{"code": "C1780", "type": "HCPCS"}, {"code": "771036491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1471.87, "maximum": 3761.44, "gross_charge": 4088.53, "discounted_cash": 5110.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1512.75, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1512.75, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1512.75, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3066.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3066.39, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3761.44, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1471.87, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3066.39, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "10MM BABCOCK 10MM COVIDIEN", "code_information": [{"code": "771036303", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 385.73, "discounted_cash": 482.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10MM CURVED TIP CURETTE", "code_information": [{"code": "771003631", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.23, "discounted_cash": 54.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10MM J-P PERFORATED ENTIRE LENGTH", "code_information": [{"code": "771006763", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 82.87, "discounted_cash": 103.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10MM M/L CLIP APPLIER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.28, "maximum": 649.84, "gross_charge": 706.35, "discounted_cash": 882.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 261.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 261.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 261.34, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 529.76, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 529.76, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 649.84, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 254.28, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 529.76, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "10MM STRAIGHT CURETTE", "code_information": [{"code": "771011500", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 34.24, "discounted_cash": 42.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10MM TEP OCCLUDER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771020204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 329.29, "maximum": 841.54, "gross_charge": 914.72, "discounted_cash": 1143.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 338.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 338.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 338.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 686.04, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 686.04, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 841.54, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 329.29, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 686.04, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "10X15 COMFORT GEL PACKS", "code_information": [{"code": "771018338", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 61.09, "discounted_cash": 76.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "10g ULTRASOUND PROBE", "code_information": [{"code": "771042001", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1294.11, "discounted_cash": 1617.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11 FR 70 CM", "code_information": [{"code": "771027362", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 825.19, "discounted_cash": 1031.49, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11 TI CANN RETRO ANTEGRADE FEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771049036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1648.14, "maximum": 4211.92, "gross_charge": 4578.18, "discounted_cash": 5722.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1693.92, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1693.92, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1693.92, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3433.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3433.63, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4211.92, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1648.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3433.63, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "11 TROCAR BLADELESS ENDOPATH", "code_information": [{"code": "771026457", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 799.9, "discounted_cash": 999.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11FR CURVED CURETTE TIP SUCTION", "code_information": [{"code": "771008169", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.23, "discounted_cash": 54.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11FR INTRODUCER KIT", "code_information": [{"code": "771004786", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 594.34, "discounted_cash": 742.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11G BLADED MAMMOTONE PROBE", "code_information": [{"code": "771027406", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1645.39, "discounted_cash": 2056.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11G DISPOSABLE PROBE GUIDE", "code_information": [{"code": "771027408", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 83.43, "discounted_cash": 104.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11G MAMMOTONE PROBE", "code_information": [{"code": "771027407", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1531.14, "discounted_cash": 1913.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11G MARKERS", "code_information": [{"code": "771042113", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 726.43, "discounted_cash": 908.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11G/115 TARGET SET", "code_information": [{"code": "771042115", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1348.91, "discounted_cash": 1686.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "11G/145 TARGET SET", "code_information": [{"code": "771042114", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1348.91, "discounted_cash": 1686.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12 DEG TRUESPAN MENISCAL RPR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771038733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1099.38, "maximum": 2809.53, "gross_charge": 3053.84, "discounted_cash": 3817.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1129.92, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1129.92, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1129.92, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2290.38, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2290.38, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2809.53, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1099.38, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2290.38, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "12 FR X 45 CM ANSEL 1 INTRODUCER", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "771030644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 403.15, "maximum": 1030.28, "gross_charge": 1119.87, "discounted_cash": 1399.84, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 839.9, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 839.9, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1030.28, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 403.15, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 839.9, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "12 FRENCH INTRODUCER 30CM 221154", "code_information": [{"code": "771023451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 863.83, "discounted_cash": 1079.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12\" GONIMETERS", "code_information": [{"code": "771013103", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 186.15, "discounted_cash": 232.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12-LEAD ECG PERFORMED", "code_information": [{"code": "3120F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "120 DEGREE SLEEVE", "code_information": [{"code": "771020548", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2121.03, "discounted_cash": 2651.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "120IN TUBING,GENERAL", "code_information": [{"code": "771004285", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12FR ALL PURPOSE CATHETER", "code_information": [{"code": "771007732", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 266.65, "discounted_cash": 333.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12FR INTRODUCER SET", "code_information": [{"code": "C1892", "type": "HCPCS"}, {"code": "771009193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 185.63, "maximum": 474.39, "gross_charge": 515.65, "discounted_cash": 644.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 190.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 190.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 190.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 386.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 386.73, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 474.39, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 185.63, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 386.73, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "12MM BLADELESS TROCAR", "code_information": [{"code": "771026255", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 819.16, "discounted_cash": 1023.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12MM CURVED TIP 615", "code_information": [{"code": "771003150", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.23, "discounted_cash": 54.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12MM STABLIZING TREAD ETHICON", "code_information": [{"code": "771012271", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 71.48, "discounted_cash": 89.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12MM STAPLER CANN. SEAL", "code_information": [{"code": "771035552", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 188.27, "discounted_cash": 235.34, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12MM TROCAR ETHICON", "code_information": [{"code": "771012270", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 765.77, "discounted_cash": 957.21, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "12x4.2MM SD FIX SCR GOLD/SLVR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771038258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 111.51, "maximum": 284.97, "gross_charge": 309.76, "discounted_cash": 387.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 114.61, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 114.61, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 114.61, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 232.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 232.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 284.97, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 111.51, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 232.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "13CM HEMODIALYSIS CATHETER", "code_information": [{"code": "771024003", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 829.7, "discounted_cash": 1037.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "13G PROBE", "code_information": [{"code": "771041903", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.75, "discounted_cash": 1698.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "14\" DELTA DESIGN ROLL", "code_information": [{"code": "771017053", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 143.0, "discounted_cash": 178.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "14GX16CM MONOPTY BARD DISP", "code_information": [{"code": "771039935", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 382.87, "discounted_cash": 478.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "14MM CURVED TIP 616", "code_information": [{"code": "771010681", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 44.65, "discounted_cash": 55.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "15/2 ADDITIONAL FRACTURE", "code_information": [{"code": "771030500", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 11671.31, "discounted_cash": 14589.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "15/2 KYPHO PAK EXPRESS TRAY", "code_information": [{"code": "771029501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17256.73, "discounted_cash": 21570.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "150ML FAST TURN SYRINGE", "code_information": [{"code": "771006660", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 29.77, "discounted_cash": 37.21, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "15G HYDRO MARKCOIL 3 TITAM", "code_information": [{"code": "771041904", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 734.86, "discounted_cash": 918.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "15X3.9CM CO-AXIAL INTRO NEEDLE", "code_information": [{"code": "771027763", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 151.73, "discounted_cash": 189.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "16F 5CC RED LATEX CATHETER", "code_information": [{"code": "771009750", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 156.35, "discounted_cash": 195.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "16FR 30CC BALLOON CONT IRRIG TEFL", "code_information": [{"code": "771003120", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.38, "discounted_cash": 31.73, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "16FR 5CC RIBBED BALLOON CATH LUBR", "code_information": [{"code": "771003015", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 101.28, "discounted_cash": 126.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "16FR T-TUBE 10018", "code_information": [{"code": "771003292", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 178.42, "discounted_cash": 223.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "16G TUBING ADAPTOR", "code_information": [{"code": "771009923", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "16GX2 IV CATH NOVALON", "code_information": [{"code": "771001100", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "17 Hydroxyprogesterone, LC/MS/MS", "code_information": [{"code": "83498", "type": "CPT"}, {"code": "7014D6063", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 26.35, "maximum": 130.47, "gross_charge": 141.82, "discounted_cash": 177.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 93.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 93.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 93.6, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 106.36, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 106.36, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 130.47, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 28.53, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 28.53, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 51.05, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 106.36, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "17X11.8 CO-AXIAL", "code_information": [{"code": "771024911", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 160.86, "discounted_cash": 201.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "17X6.8 CO-AXIAL", "code_information": [{"code": "771024910", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 150.46, "discounted_cash": 188.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "18 FR FEEDING TUBE REPLACEMENT", "code_information": [{"code": "771024883", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 508.64, "discounted_cash": 635.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "18 GA. IV CATH", "code_information": [{"code": "771012970", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.94, "discounted_cash": 22.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "180 GUIDE WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771001575", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 38.94, "maximum": 99.52, "gross_charge": 108.18, "discounted_cash": 135.23, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 81.13, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 81.13, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 99.52, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 38.94, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 81.13, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "18F 5CC SILICONE FOLEY CATHETER", "code_information": [{"code": "771023687", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.54, "discounted_cash": 54.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "18FR 30CC BALLOON CONT IRRIG TEFL", "code_information": [{"code": "771003121", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 101.28, "discounted_cash": 126.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "18FR LEFT VENTRICULAR VENT CATH", "code_information": [{"code": "771007858", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 248.81, "discounted_cash": 311.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "18FR/FOLEY/5CC CATHETER", "code_information": [{"code": "771004863", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 101.28, "discounted_cash": 126.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "18G 16CM MONOPTY BIOPSY SYSTEM", "code_information": [{"code": "771007917", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 364.89, "discounted_cash": 456.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "18G X 10CM 22MM MONOPTY BIOPSY", "code_information": [{"code": "771024001", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 326.24, "discounted_cash": 407.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "18MM MYOCARDIAL TEMP PROBE", "code_information": [{"code": "771007309", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 297.86, "discounted_cash": 372.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1DOSE MENIG VAC BTWN 11 & 13", "code_information": [{"code": "G9414", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1N - CVCU PRIVATE", "code_information": [{"code": "631010186", "type": "CDM"}, {"code": "214", "type": "RC"}], "standard_charges": [{"gross_charge": 4666.09, "discounted_cash": 5832.61, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1N - CVCU-RECOV EXT STAY", "code_information": [{"code": "631010195", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 4666.09, "discounted_cash": 5832.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1N - ICU ROOM", "code_information": [{"code": "631010182", "type": "CDM"}, {"code": "200", "type": "RC"}], "standard_charges": [{"gross_charge": 6726.09, "discounted_cash": 8407.61, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1N OBSERVATION", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "604220240", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 289.15, "gross_charge": 314.3, "discounted_cash": 392.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 289.15, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 113.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1N PRIVATE ROOM & BOARD", "code_information": [{"code": "604020225", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1ST ART THROMBO NON COR", "code_information": [{"code": "37211", "type": "CPT"}, {"code": "704308656", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 4766.1, "maximum": 23954.82, "gross_charge": 13239.17, "discounted_cash": 16548.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8737.85, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8737.85, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8737.85, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9929.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9929.37, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8901.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 12180.03, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5399.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4987.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5399.11, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4766.1, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9929.37, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}], "standard_charges": [{"minimum": 244.56, "maximum": 244.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 244.56, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}], "standard_charges": [{"minimum": 184.31, "maximum": 184.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 184.31, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}], "standard_charges": [{"minimum": 116.65, "maximum": 116.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 116.65, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE HIGH MDM 50", "code_information": [{"code": "99306", "type": "CPT"}], "standard_charges": [{"minimum": 257.33, "maximum": 257.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 257.33, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE MODERATE MDM 35", "code_information": [{"code": "99305", "type": "CPT"}], "standard_charges": [{"minimum": 188.25, "maximum": 188.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 188.25, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE SF/LOW MDM 25", "code_information": [{"code": "99304", "type": "CPT"}], "standard_charges": [{"minimum": 113.27, "maximum": 113.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 113.27, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST ORDER", "code_information": [{"code": "36014", "type": "CPT"}, {"code": "704309608", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 742.57, "maximum": 8073.31, "gross_charge": 2062.71, "discounted_cash": 2578.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1361.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1361.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1361.38, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1547.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1547.03, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1897.69, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 742.57, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1547.03, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST PSYC COLLAB CARE MGMT", "code_information": [{"code": "99492", "type": "CPT"}], "standard_charges": [{"minimum": 85.35, "maximum": 698.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 504.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 547.2, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 148.63, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 92.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 85.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 92.39, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST VENOUS THOMBO", "code_information": [{"code": "37212", "type": "CPT"}, {"code": "713550300", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 2904.15, "maximum": 23954.82, "gross_charge": 13239.17, "discounted_cash": 16548.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8737.85, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8737.85, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8737.85, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9929.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9929.37, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5162.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 12180.03, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4766.1, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9929.37, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST/SBSQ PSYC COLLAB CARE", "code_information": [{"code": "99494", "type": "CPT"}], "standard_charges": [{"minimum": 83.37, "maximum": 698.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 504.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 547.2, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 83.37, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1X3 PPLYMEM CLOTH ADHESIVE", "code_information": [{"code": "771019131", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1X3 PPLYMM FILM", "code_information": [{"code": "771019130", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2 1/4 OSTOMY BARRIER CERAPLUS", "code_information": [{"code": "771042860", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 78.66, "discounted_cash": 98.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2 3/4 OSTOMY BARRIER CERAPLUS", "code_information": [{"code": "771042859", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 78.66, "discounted_cash": 98.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4207", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.35, "maximum": 0.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.35, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 NO WL", "code_information": [{"code": "G9877", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 WL", "code_information": [{"code": "G9879", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 NO WL", "code_information": [{"code": "G9876", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 WL", "code_information": [{"code": "G9878", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 13-15 WL", "code_information": [{"code": "G9882", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 16-18 WL", "code_information": [{"code": "G9883", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 19-21 WL", "code_information": [{"code": "G9884", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 22-24 WL", "code_information": [{"code": "G9885", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 IN YELLOW CAST", "code_information": [{"code": "771042678", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 195.28, "discounted_cash": 244.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2 LEVEL PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771033483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1986.45, "maximum": 5076.5, "gross_charge": 5517.94, "discounted_cash": 6897.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2041.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2041.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2041.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4138.45, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4138.45, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5076.5, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1986.45, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4138.45, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2\"SOFT TEMPRAFOAM W/C CUSHION", "code_information": [{"code": "771006637", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 662.79, "discounted_cash": 828.49, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2+ ANTI-HYPRTNSV AGENTS TKN", "code_information": [{"code": "4145F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ ANTIPSY SCHIZ", "code_information": [{"code": "G0032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ BENZO SEIZ", 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"standard_charge_dollar": 1006.17, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1234.23, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 482.96, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1006.17, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2.0 TI LOCKING SCR SLF-TPNG SD RECESS 12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 117.61, "maximum": 300.56, "gross_charge": 326.7, "discounted_cash": 408.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 120.87, "methodology": "percent of total billed 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"billing_class": "facility"}]}, {"description": "2.4 TI VA 2-COL DRP NRW 6H HD/4H SFT/LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 146.39, "maximum": 374.11, "gross_charge": 406.65, "discounted_cash": 508.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 150.46, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 150.46, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 150.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 304.98, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 304.98, "methodology": "percent of 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{"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1404.55, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2926.14, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2.7/3.5 VA LAT DSTL HUM PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771049034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1366.67, "maximum": 3492.62, "gross_charge": 3796.33, "discounted_cash": 4745.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1404.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1404.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1404.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2847.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2847.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3492.62, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1366.67, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2847.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2.7MM VA LCPLECRANON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771035462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.75, "maximum": 4699.02, "gross_charge": 5107.64, "discounted_cash": 6384.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1889.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1889.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1889.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3830.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3830.73, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4699.02, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1838.75, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3830.73, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2.9 DRILLBIT", "code_information": [{"code": "771033478", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1177.47, "discounted_cash": 1471.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20 FR L.P. VOICE PROSTHESIS", "code_information": [{"code": "771015440", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 420.1, "discounted_cash": 525.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20 FR. L.P. VOICE PROSTHESIS", "code_information": [{"code": "771013902", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 372.33, "discounted_cash": 465.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20 GA. IV CATH", "code_information": [{"code": "771012971", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.94, "discounted_cash": 22.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20 IN HIGH PRESSURE CONTRAST LINE", "code_information": [{"code": "771027572", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 31.3, "discounted_cash": 39.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20 JEJUNAL", "code_information": [{"code": "771043083", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 798.09, "discounted_cash": 997.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20\" PRESSURE INJECTOR LINE", "code_information": [{"code": "771011930", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 35.09, "discounted_cash": 43.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20+ CC SYRINGE ONLY", "code_information": [{"code": "A4213", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.53, "maximum": 0.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.53, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.84, "maximum": 93.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 53.88, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 37.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 37.72, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "20CM IM DISP BAYONET 1.0MM TIP", "code_information": [{"code": "771038530", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1760.06, "discounted_cash": 2200.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20F 5CC SILICONE FOLEY CATHETER", "code_information": [{"code": "771023688", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 42.72, "discounted_cash": 53.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20FR 30CC 3-WAY CATH", "code_information": [{"code": "771010439", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 101.28, "discounted_cash": 126.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20FR LPVP INDWELLING 10MM REPLACE", "code_information": [{"code": "771019457", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 443.86, "discounted_cash": 554.83, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20FR REPLACEMENT FEEDING TUBE", "code_information": [{"code": "771040385", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 300.67, "discounted_cash": 375.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20FR/5CC 3WAY FOLEY CATHETER", "code_information": [{"code": "771004865", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 87.1, "discounted_cash": 108.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20G 1 1/2\" HUBER NEEDLE", "code_information": [{"code": "771020207", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 50.69, "discounted_cash": 63.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20G 7.5CM HAWKINS BRST LOC. NEEDL", "code_information": [{"code": "771027452", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 342.54, "discounted_cash": 428.18, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20G ANTERIOR VIT SIT", "code_information": [{"code": "771035333", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5842.55, "discounted_cash": 7303.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "20G POWERGLIDE PRO", "code_information": [{"code": "771048925", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 764.23, "discounted_cash": 955.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "21 GA BTRFLY NEEDLE & TUBING SET", "code_information": [{"code": "771019278", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "22 GA. IV CATH", "code_information": [{"code": "771012972", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.94, "discounted_cash": 22.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "22FR 30CC 3WAY FOLEY CATHETER", "code_information": [{"code": "771006031", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 178.71, "discounted_cash": 223.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "22FR FOLEY CATHETERS 5CC BAG", "code_information": [{"code": "771004410", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 101.28, "discounted_cash": 126.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "22FR PUNTURE DILATOR", "code_information": [{"code": "771016885", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 537.71, "discounted_cash": 672.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "22FR-30CC FOLEY CATHETER", "code_information": [{"code": "771003742", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 88.48, "discounted_cash": 110.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "22FR/5CC 3 WAY FOLEY CATHETER", "code_information": [{"code": "771004866", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 138.51, "discounted_cash": 173.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "23 GA BTRFLY NEEDLE & TUBING SET", "code_information": [{"code": "771019279", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "23CM IM DISP BAYONET 1.5MM TIP", "code_information": [{"code": "771038531", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1760.06, "discounted_cash": 2200.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "24 GA. IV CATH", "code_information": [{"code": "771012973", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 29.77, "discounted_cash": 37.21, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "24\" SHOE HORNS", "code_information": [{"code": "771002970", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 74.44, "discounted_cash": 93.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "24HR REFLUX", "code_information": [{"code": "91034", "type": "CPT"}, {"code": "703400237", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 489.58, "maximum": 1251.34, "gross_charge": 1360.16, "discounted_cash": 1700.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 897.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 897.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 897.7, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 577.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 800.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 800.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 626.82, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1020.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1020.12, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 893.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1251.34, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 529.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 489.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 529.96, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 489.65, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1020.12, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "24HR REFLUX PRO FEE", "code_information": [{"code": "703400241", "type": "CDM"}, {"code": "960", "type": "RC"}], "standard_charges": [{"gross_charge": 580.28, "discounted_cash": 725.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "24HR URINE COLL KIT - CHRG ONLY", "code_information": [{"code": "701101967", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.55, "discounted_cash": 23.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "25 GA 3.5\" SPINAL NEEDLE", "code_information": [{"code": "771027278", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.83, "discounted_cash": 21.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "250ML STERILE WATER", "code_information": [{"code": "771041156", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.95, "discounted_cash": 11.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "28FR WIRE REINFORCED VENOUS RETUR", "code_information": [{"code": "771007856", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 407.46, "discounted_cash": 509.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2D CEPHAL RADIO IMAGE", "code_information": [{"code": "D0702", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.55, "maximum": 108.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D CEPHALOMETRIC IMAGE", "code_information": [{"code": "D0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.24, "maximum": 150.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 150.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 150.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 150.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 150.74, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D ECHO M MODE/COLOR FLOW", "code_information": [{"code": "93306", "type": "CPT"}, {"code": "714060005", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 505.9, "maximum": 2064.45, "gross_charge": 2243.97, "discounted_cash": 2804.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1481.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1481.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1481.02, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 690.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 748.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1682.97, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1682.97, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 893.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2064.45, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 547.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 505.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 547.63, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 807.82, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1682.97, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D HELICIAL 10X20 COIL", "code_information": [{"code": "771031245", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 859.49, "discounted_cash": 1074.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2D HELICIAL 8X20 COIL", "code_information": [{"code": "771031244", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 911.89, "discounted_cash": 1139.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2D ORAL/FACIAL PHOTO IMAGE", "code_information": [{"code": "D0703", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.0, "maximum": 87.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [{"code": "C8925", "type": "HCPCS"}], "standard_charges": [{"minimum": 690.5, "maximum": 1296.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 690.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 748.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1296.9, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 789.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 728.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 789.1, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}], "standard_charges": [{"minimum": 690.5, "maximum": 1296.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 690.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 748.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1296.9, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 789.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 728.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 789.1, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,FU", "code_information": [{"code": "C8924", "type": "HCPCS"}], "standard_charges": [{"minimum": 329.52, "maximum": 956.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 690.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 748.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 622.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 356.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 329.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 356.7, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2GM WOUND PACKING", "code_information": [{"code": "771007901", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 61.09, "discounted_cash": 76.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2IN HYPOFIX TAPE", "code_information": [{"code": "771008191", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 96.78, "discounted_cash": 120.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2N - RECOVERY - EXTENDED STAY", "code_information": [{"code": "600020055", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2N INFANT CARE", "code_information": [{"code": "621010156", "type": "CDM"}, {"code": "170", "type": "RC"}], "standard_charges": [{"gross_charge": 1663.6, "discounted_cash": 2079.5, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "2N NICU Stepdown", "code_information": [{"code": "621010158", "type": "CDM"}, {"code": "172", "type": "RC"}], "standard_charges": [{"gross_charge": 2741.32, "discounted_cash": 3426.65, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "2N OBSERVATION", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "600210015", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 289.15, "gross_charge": 314.3, "discounted_cash": 392.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 289.15, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 113.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2N PRIVATE ROOM & BOARD", "code_information": [{"code": "600010000", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "2SE - RECOVERY - EXTENDED STAY", "code_information": [{"code": "601020033", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2SE OBSERVATION", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "601010046", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 307.63, "gross_charge": 334.39, "discounted_cash": 417.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 220.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 220.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 220.69, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 250.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 250.79, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 307.63, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 120.38, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 250.79, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2SE PRIVATE ROOM & BOARD", "code_information": [{"code": "601010026", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "2STAGE VENOUS RETURN CATHETER 36F", "code_information": [{"code": "771006714", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 193.59, "discounted_cash": 241.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2SW - RECOVERY - EXTENDED STAY", "code_information": [{"code": "601020034", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "2SW OBSERVATION", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "601010047", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 289.15, "gross_charge": 314.3, "discounted_cash": 392.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 289.15, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 113.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2SW PRIVATE ROOM & BOARD", "code_information": [{"code": "601010027", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "2VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90650", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4208", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.21, "maximum": 0.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 COMP FOOT EXAM COMPLETED", "code_information": [{"code": "G9226", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 FR SINGLE LUMEN MIDLINE TRIM", "code_information": [{"code": "771042923", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1327.22, "discounted_cash": 1659.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3 IN YELLOW CAST", "code_information": [{"code": "771042677", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 224.8, "discounted_cash": 281.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3 PRONG GRASPING FORCEP", "code_information": [{"code": "771030499", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.19, "discounted_cash": 1385.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3 TRIATHLON TS PLUS TIBIAL INSERT X3 POL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771039204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2199.61, "maximum": 5621.23, "gross_charge": 6110.04, "discounted_cash": 7637.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2260.71, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2260.71, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2260.71, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4582.53, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4582.53, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5621.23, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2199.61, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4582.53, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 TRIATHLON TS PLUS TIBIAL INSERT X3 POL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771039347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2199.61, "maximum": 5621.23, "gross_charge": 6110.04, "discounted_cash": 7637.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2260.71, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2260.71, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2260.71, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4582.53, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4582.53, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5621.23, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2199.61, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4582.53, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3\" COBAN SELF ADHERENT WRAP", "code_information": [{"code": "771019337", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.23, "discounted_cash": 22.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3-0 MAXON SH SUTURE", "code_information": [{"code": "771030172", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 19.66, "discounted_cash": 24.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3-0 PROLENE SH,8522H", "code_information": [{"code": "771003180", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 53.65, "discounted_cash": 67.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3-0 VICRYL", "code_information": [{"code": "771003185", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 95.53, "discounted_cash": 119.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3-0 VICRYL CT-1,J944H", "code_information": [{"code": "771003192", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.38, "discounted_cash": 31.73, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3-0 VICRYL SUTURE", "code_information": [{"code": "771005157", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 26.66, "discounted_cash": 33.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3.2MM CARBIDE SIDE CUTTER", "code_information": [{"code": "771025250", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 994.94, "discounted_cash": 1243.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3.5 CORTICAL SCREW SLFTPNG 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771049777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 39.07, "maximum": 99.86, "gross_charge": 108.55, "discounted_cash": 135.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 40.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 40.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 40.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 81.41, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 81.41, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 99.86, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 39.07, "methodology": "percent of total billed 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653.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 653.37, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 801.47, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 313.62, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 653.37, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3.5 SELF TAPPING SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771033480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 651.5, "gross_charge": 708.16, "discounted_cash": 885.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 262.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 262.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 262.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 531.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 531.12, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 651.5, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 254.93, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 531.12, "methodology": "percent of total 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"discounted_cash": 14887.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4406.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4406.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4406.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 8932.36, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8932.36, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 10957.03, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4287.53, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 8932.36, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3/4\" HEEL/SOLE ELEV", "code_information": [{"code": "771009668", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 272.57, "discounted_cash": 340.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "30 DEG. 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"outpatient", "billing_class": "facility"}]}, {"description": "36 FR CHEST TUBE 14036", "code_information": [{"code": "771025208", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 131.05, "discounted_cash": 163.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "360 MULTI-IMPLANT SYSTEM", "code_information": [{"code": "771036057", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 20502.38, "discounted_cash": 25627.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "36FR CHEST TUBE", "code_information": [{"code": "771003300", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 50.69, "discounted_cash": 63.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3D DENTAL SCAN DIRECT", "code_information": [{"code": "D0801", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.55, "maximum": 32.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D DENTAL SCAN INDIRECT", "code_information": [{"code": "D0802", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.55, "maximum": 32.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}], "standard_charges": [{"minimum": 690.5, "maximum": 956.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 690.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 956.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 748.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D FACIAL SCAN DIRECT", "code_information": [{"code": "D0803", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.55, "maximum": 32.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D FACIAL SCAN INDIRECT", "code_information": [{"code": "D0804", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.55, "maximum": 32.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D PRINT OF 3D SURFACE SCAN", "code_information": [{"code": "D0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.55, "maximum": 32.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 32.55, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76376", "type": "CPT"}], "standard_charges": [{"minimum": 40.16, "maximum": 40.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D TREATMENT COMP DOSIMETRY", "code_information": [{"code": "77295", "type": "CPT"}, {"code": "700040040", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 826.04, "maximum": 2640.42, "gross_charge": 2294.56, "discounted_cash": 2868.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1514.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1514.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1514.4, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1267.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1267.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1267.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1267.43, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1720.92, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1720.92, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2640.42, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2110.99, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1366.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1262.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1366.6, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 826.04, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1720.92, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D VOL IMG&RCNSTJ BRST/AX", "code_information": [{"code": "694T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}], "standard_charges": [{"minimum": 223.03, "maximum": 241.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 241.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 223.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 241.43, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D-CRT/IMRT RECEIVED", "code_information": [{"code": "4165F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3M RESTON PAD", "code_information": [{"code": "771016588", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 31.3, "discounted_cash": 39.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3M ROUND ELECTRODES", "code_information": [{"code": "771013308", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.86, "discounted_cash": 41.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3MM ACCU-CUT OSTEOTOMY KIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 738.16, "maximum": 1886.43, "gross_charge": 2050.47, "discounted_cash": 2563.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 758.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 758.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 758.67, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1537.85, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1537.85, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1886.43, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 738.16, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1537.85, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3N OBSERVATION", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "603210090", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 289.15, "gross_charge": 314.3, "discounted_cash": 392.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 289.15, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 113.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 235.72, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3N PRIVATE ROOM & BOARD", "code_information": [{"code": "603010086", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "3N RECOVERY - EXTENDED STAY", "code_information": [{"code": "603210051", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3X5 RECTANGULAR ELECTRODE", "code_information": [{"code": "771020960", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 46.34, "discounted_cash": 57.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obtained from previous diagnostic computed tomographic or magnetic resonance examination of the same anatomy", "code_information": [{"code": "C8001", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.24, "maximum": 87.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4 0 MONOCRYL KS NEEDLE 27INCH", "code_information": [{"code": "771035453", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 243.05, "discounted_cash": 303.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4 EM CORE SESSIONS", "code_information": [{"code": "G9874", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4 FR COAXIAL", "code_information": [{"code": "771027314", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 713.5, "discounted_cash": 891.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4 FR MICROPUNCTURE SET", "code_information": [{"code": "771019626", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 198.1, "discounted_cash": 247.63, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4 FRENCH AR MOD CATHETER", "code_information": [{"code": "771041708", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 519.88, "discounted_cash": 649.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4 FRENCH OBTURATOR", "code_information": [{"code": "771041709", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 969.52, "discounted_cash": 1211.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4 FRENCH SUPER TORQUE SIM 1 CATHETER", "code_information": [{"code": "771041653", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 144.7, "discounted_cash": 180.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4 POINT SPORT BRACE", "code_information": [{"code": "771008140", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1120.15, "discounted_cash": 1400.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4\" MEDIGRIP SELF ADHERENT", "code_information": [{"code": "771002424", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 30.87, "discounted_cash": 38.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4-0 VICRYL RB-1", "code_information": [{"code": "771003608", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 19.66, "discounted_cash": 24.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4.0 SCREW LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771033473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 452.22, "maximum": 1155.68, "gross_charge": 1256.18, "discounted_cash": 1570.23, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 464.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 464.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 464.78, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 942.13, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 942.13, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1155.68, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 452.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 942.13, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4.0 TAP", "code_information": [{"code": "771033002", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1065.06, "discounted_cash": 1331.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4.1 FR JB1", "code_information": [{"code": "771009789", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 188.26, "discounted_cash": 235.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4.1 FR JB2", "code_information": [{"code": "771009790", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 140.05, "discounted_cash": 175.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4.5 SCREW CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771033477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 760.28, "maximum": 1942.93, "gross_charge": 2111.89, "discounted_cash": 2639.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 781.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 781.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 781.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1583.91, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1583.91, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1942.93, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 760.28, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1583.91, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4.5 SHUTTLE SLIPCATH 135CM", "code_information": [{"code": "771029746", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 884.79, "discounted_cash": 1105.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4.5 TI MULTILOC SCREW LENGTH 32-STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 248.54, "maximum": 635.16, "gross_charge": 690.4, "discounted_cash": 863.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 635.16, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 248.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4.5 TI MULTILOC SCREW LENGTH 40-STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 248.54, "maximum": 635.16, "gross_charge": 690.4, "discounted_cash": 863.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 635.16, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 248.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4.5 TI MULTILOC SCREW LGTH 42-STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 248.54, "maximum": 635.16, "gross_charge": 690.4, "discounted_cash": 863.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 635.16, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 248.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4.5 TI MULTILOC SCREW LNGTH 36-STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 248.54, "maximum": 635.16, "gross_charge": 690.4, "discounted_cash": 863.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 255.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 635.16, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 248.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 517.8, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4.5 VA LCP CURVED COND PL 6 HOLE 159 RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1907.06, "maximum": 4873.6, "gross_charge": 5297.4, "discounted_cash": 6621.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1960.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1960.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1960.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3973.05, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3973.05, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4873.6, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1907.06, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3973.05, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4.5 VA-LCP CRVD COND PL/6HL/159/LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1907.06, "maximum": 4873.6, "gross_charge": 5297.4, "discounted_cash": 6621.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1960.03, "methodology": "percent of total billed 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VALCP CR CON PL 14H 301LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771049967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2217.79, "maximum": 5667.68, "gross_charge": 6160.53, "discounted_cash": 7700.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2279.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2279.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2279.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4620.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4620.39, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5667.68, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2217.79, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4620.39, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4.5MM X 24 CORTICAL SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771049770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 42.98, "maximum": 109.85, "gross_charge": 119.41, "discounted_cash": 149.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 44.18, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 44.18, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 44.18, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 89.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 89.55, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 109.85, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 42.98, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 89.55, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4.5X16 JACK FROST GEL PACK", "code_information": [{"code": "771013858", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 47.76, "discounted_cash": 59.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4.75 BC KNOTLESS SWIVELOCK W/TAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771038296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1056.61, "maximum": 2700.24, "gross_charge": 2935.05, "discounted_cash": 3668.81, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1085.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1085.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1085.96, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2201.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2201.28, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2700.24, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1056.61, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2201.28, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "40 CM SHOOT N SEE", "code_information": [{"code": "771043471", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 139.08, "discounted_cash": 173.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "40 FIBEROPTIX SIMPLE CONNECT IABP", "code_information": [{"code": "771049740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3909.26, "discounted_cash": 4886.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "40-75Y W/TYPE 1/2 W/LDL-C RS", "code_information": [{"code": "G9676", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "40CC 8F FIBEROPTIX IAB", "code_information": [{"code": "771040463", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4485.17, "discounted_cash": 5606.46, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "410FX SIZER NATRELLE FULL HGT", "code_information": [{"code": "771035323", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1458.5, "discounted_cash": 1823.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "424 MEDICAL ADHESIVE KIT", "code_information": [{"code": "771041587", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 418.71, "discounted_cash": 523.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "44MM HUMERAL HEAD TEST A SMR SHOULDER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2614.84, "maximum": 6682.37, "gross_charge": 7263.45, "discounted_cash": 9079.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2687.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2687.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2687.47, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 5447.58, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 5447.58, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 6682.37, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2614.84, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 5447.58, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "45/28 SIZE 2 GRAY SELF CEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771006950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1413.83, "maximum": 3613.13, "gross_charge": 3927.32, "discounted_cash": 4909.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1453.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1453.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1453.1, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2945.49, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2945.49, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3613.13, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1413.83, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2945.49, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4F (HN) NEWTON 100CN", "code_information": [{"code": "771024199", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 195.15, "discounted_cash": 243.94, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4F INFINITI PIG 145", "code_information": [{"code": "771024962", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 262.15, "discounted_cash": 327.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4FMPA2125CM", "code_information": [{"code": "771027560", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 132.06, "discounted_cash": 165.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4FR AR1 MOD", "code_information": [{"code": "771019066", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 113.22, "discounted_cash": 141.53, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4FR AVANTI", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "771023151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 43.49, "maximum": 111.14, "gross_charge": 120.81, "discounted_cash": 151.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 44.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 44.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 44.69, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 90.6, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 90.6, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 111.14, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 43.49, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 90.6, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4FR INFINITI JL4", "code_information": [{"code": "771023150", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 132.06, "discounted_cash": 165.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4FR INFINITI PIGTAIL", "code_information": [{"code": "771023152", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 132.06, "discounted_cash": 165.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4FR JL5", "code_information": [{"code": "771019072", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 113.22, "discounted_cash": 141.53, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4FR JR4", "code_information": [{"code": "771019068", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 120.81, "discounted_cash": 151.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4FR JR5 CATHETER 538-523", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771023635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 43.49, "maximum": 111.14, "gross_charge": 120.81, "discounted_cash": 151.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 44.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 44.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 44.69, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 90.6, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 90.6, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 111.14, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 43.49, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 90.6, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4FR MULTIPAC", "code_information": [{"code": "771023294", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 366.71, "discounted_cash": 458.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4FR PIGTAIL MICRO LOOP", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771039914", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 20.72, "maximum": 52.97, "gross_charge": 57.58, "discounted_cash": 71.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 21.3, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 21.3, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 21.3, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 43.18, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 43.18, "methodology": "percent of total 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"methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 83.17, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 168.6, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 168.6, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 206.81, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 80.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 168.6, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4MM ECCENTRICAL ADAPTER SMR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1307.41, "maximum": 3341.17, "gross_charge": 3631.71, "discounted_cash": 4539.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1343.73, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1343.73, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1343.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2723.78, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2723.78, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3341.17, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1307.41, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2723.78, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90649", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90649", "type": "CPT"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", 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"HCPCS"}, {"code": "602010071", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 307.63, "gross_charge": 334.39, "discounted_cash": 417.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 220.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 220.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 220.69, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 250.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 250.79, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 307.63, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 120.38, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 250.79, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4WN PRIVATE ROOM & BOARD", "code_information": [{"code": "602010051", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "4WS - RECOVERY - EXTENDED STAY", "code_information": [{"code": "601020039", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4WS DELUXE ROOM & BOARD", "code_information": [{"code": "602010073", "type": "CDM"}, {"code": "140", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.01, "discounted_cash": 2137.51, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "4WS OBSERVATION", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "602010072", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 289.15, "gross_charge": 314.3, "discounted_cash": 392.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 207.43, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 53.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue 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[{"code": "602010052", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.56, "discounted_cash": 1946.95, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "4WS SUITE ROOM & BOARD", "code_information": [{"code": "602010074", "type": "CDM"}, {"code": "140", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.01, "discounted_cash": 2137.51, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "4X2 PLOYMEM CLOTH ADHESIVE", "code_information": [{"code": "771019133", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "4X2 POLYMEM FILM", "code_information": [{"code": "771019132", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.23, "discounted_cash": 22.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5 1/4 INCH DISPOSABLE SCISSOR, ST", "code_information": [{"code": "771023834", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 35.09, "discounted_cash": 43.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5 FR CHECK-FLO PERFORMER INTRO", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "771029749", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 222.56, "maximum": 568.78, "gross_charge": 618.24, "discounted_cash": 772.8, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 463.68, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 463.68, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 568.78, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 222.56, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 463.68, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5 FR OBTURATORS", "code_information": [{"code": "771039831", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 53.37, "discounted_cash": 66.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5 FR PIGTAIL 155 ANGLE", "code_information": [{"code": "771043369", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 84.29, "discounted_cash": 105.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5 FR RADIAL TIG 4.0 110CM", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771043149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 18.7, "maximum": 47.81, "gross_charge": 51.97, "discounted_cash": 64.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 19.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 19.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 19.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 38.97, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 38.97, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 47.81, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 18.7, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 38.97, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5 FR SWAN-GANZ THERMODULTION CATHETER", "code_information": [{"code": "771042145", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 847.26, "discounted_cash": 1059.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5 FR TRIPLE LUMEN MAX BARRIER", "code_information": [{"code": "771048488", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1451.2, "discounted_cash": 1814.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5 FR VTK 125cm", "code_information": [{"code": "C1886", "type": "HCPCS"}, {"code": "771043354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 79.4, "maximum": 202.93, "gross_charge": 220.58, "discounted_cash": 275.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 81.61, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 81.61, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 81.61, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 165.43, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 165.43, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 202.93, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 79.4, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 165.43, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5 FRENCH BRITE TIP SHEATH", "code_information": [{"code": "771041652", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 262.74, "discounted_cash": 328.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5 FRENCH GLIDESHEATH SLENDER 16CM", "code_information": [{"code": "771042436", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 684.29, "discounted_cash": 855.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5 FRENCH UMBILICAL VESSEL CATHETE", "code_information": [{"code": "771016561", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 108.72, "discounted_cash": 135.9, "setting": "outpatient", 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"methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 113.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 113.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 139.01, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 54.39, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 113.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5 HIAA, 24Hr Urine", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "7014F6096", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.02, "maximum": 139.01, "gross_charge": 151.1, "discounted_cash": 188.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 99.72, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 99.72, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 99.72, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 113.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 113.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 139.01, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 54.39, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 113.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5 HIAA, 24Hr Urine", "code_information": [{"code": "83497", "type": "CPT"}, {"code": "7014D6096", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.51, "maximum": 219.51, "gross_charge": 238.6, "discounted_cash": 298.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 157.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 157.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 157.47, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 54.07, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 54.07, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 54.07, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 54.07, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 178.95, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 178.95, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 219.51, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 12.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 85.89, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 178.95, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5 HIAA, 24Hr Urine", "code_information": [{"code": "83497", "type": "CPT"}, {"code": "7014E6096", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.51, "maximum": 219.51, "gross_charge": 238.6, "discounted_cash": 298.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 157.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 157.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 157.47, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 54.07, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 54.07, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 54.07, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 54.07, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 178.95, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 178.95, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 219.51, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 12.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 85.89, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 178.95, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5 TROCAR BLADELESS ENDOPATH", "code_information": [{"code": "771026456", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 592.8, "discounted_cash": 741.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5% DEX NS 500CC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7042", "type": "HCPCS"}, {"code": "691061015", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.62, "maximum": 3.84, "gross_charge": 4.18, "discounted_cash": 5.23, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1.96, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3.13, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3.13, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1.29, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3.84, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1.5, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3.13, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE AND 0.45% SALINE", "code_information": [{"code": "S5010", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.3, "maximum": 8.3, "estimated_discounted_cash": 44.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8.3, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE IN LAC RINGERS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7121", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.12, "maximum": 8.12, "estimated_discounted_cash": 321.68, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_percentage": 75.0, "possible_amount": 111.96, "count": "1 through 10", "median_amount": 111.96, "methodology": "percent of total billed charges", "10th_percentile": 111.96, "90th_percentile": 111.96}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 111.96, "count": "1 through 10", "median_amount": 111.96, "methodology": "percent of total billed charges", "10th_percentile": 111.96, "90th_percentile": 111.96}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8.12, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_percentage": 36.0, "possible_amount": 55.9, "count": "1 through 10", "median_amount": 55.9, "methodology": "percent of total billed charges", "10th_percentile": 55.9, "90th_percentile": 55.9}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 120.58, "count": "1 through 10", "median_amount": 120.93, "methodology": "percent of total billed charges", "10th_percentile": 119.79, "90th_percentile": 121.01}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE IN LAC RINGERS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7121", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 321.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 47.0, "possible_amount": 71.87, "count": "1 through 10", "median_amount": 71.87, "methodology": "percent of total billed charges", "10th_percentile": 71.87, "90th_percentile": 71.87}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 47.0, "possible_amount": 71.87, "count": "1 through 10", "median_amount": 71.87, "methodology": "percent of total billed charges", "10th_percentile": 71.87, "90th_percentile": 71.87}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE IN LAC RINGERS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7121", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 321.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 47.0, "possible_amount": 71.87, "count": "1 through 10", "median_amount": 71.87, "methodology": "percent of total billed charges", "10th_percentile": 71.87, "90th_percentile": 71.87}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 47.0, "possible_amount": 71.87, "count": "1 through 10", "median_amount": 71.87, "methodology": "percent of total billed charges", "10th_percentile": 71.87, "90th_percentile": 71.87}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE WITH POTASSIUM", "code_information": [{"code": "S5012", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.99, "maximum": 4.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4.99, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE/NORMAL SALINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7042", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 322.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE/WATER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7060", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.4, "maximum": 2.05, "estimated_discounted_cash": 14.52, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2.05, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE/WATER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7060", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 14.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE/WATER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7060", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 14.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% WL MAINTND FROM BSLINE WT", "code_information": [{"code": "G9888", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.0, "maximum": 12.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5%DEXTROSE/0.45%SALINE1000ML", "code_information": [{"code": "S5013", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5+ CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4209", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.25, "maximum": 0.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": 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[{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 186.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 186.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 186.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 377.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 377.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 462.73, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 181.06, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 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{"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 186.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 186.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 377.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 377.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 462.73, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 181.06, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 377.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5.0NN X 55 LOCKING SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771049769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 181.06, "maximum": 462.73, "gross_charge": 502.97, "discounted_cash": 628.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 186.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 186.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 186.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 377.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 377.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 462.73, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 181.06, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 377.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5.2FR AR MODIFIED CATHETER", "code_information": [{"code": "771012603", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 113.22, "discounted_cash": 141.53, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5.2FR SUPER FLOW C1 2 SIDE HOLES", "code_information": [{"code": "771012847", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 177.29, "discounted_cash": 221.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "5.5 TI ROD PERC CRV 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771038266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 223.03, "maximum": 569.96, "gross_charge": 619.53, "discounted_cash": 774.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 229.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 229.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 229.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 464.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 464.64, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 569.96, 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total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 191.03, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 234.33, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 91.69, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 191.03, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 F 55CM STRAIGHT SHEATH", "code_information": [{"code": "771024423", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.5, "discounted_cash": 1406.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "7 FLD RTA PHOTO EVC RTNOPTHY", "code_information": [{"code": "2024F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FLD RTA PHOTO W/O RTNOPTHY", "code_information": [{"code": "2025F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FR INTRODUCER KIT", "code_information": [{"code": "C1892", "type": "HCPCS"}, {"code": "771022584", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 311.59, "maximum": 796.28, "gross_charge": 865.53, "discounted_cash": 1081.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 320.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 320.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 320.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 649.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 649.14, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 796.28, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 311.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 649.14, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FR LAUNCHER IMA", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771030251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 208.4, "maximum": 532.57, "gross_charge": 578.89, "discounted_cash": 723.61, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 434.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 434.16, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 532.57, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 208.4, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 434.16, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FR LAUNCHER IMA", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771030252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 208.4, "maximum": 532.57, "gross_charge": 578.89, "discounted_cash": 723.61, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 434.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 434.16, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 532.57, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 208.4, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 434.16, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FR LAUNCHER IMASH", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771030253", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 208.4, "maximum": 532.57, "gross_charge": 578.89, "discounted_cash": 723.61, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 434.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 434.16, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 532.57, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 208.4, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 434.16, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 HOLE CURVED PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771042046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2145.8, "maximum": 5483.72, "gross_charge": 5960.57, "discounted_cash": 7450.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2205.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2205.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2205.41, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4470.42, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4470.42, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5483.72, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2145.8, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4470.42, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 PROXIS EMBOLIC PROTECT SYS", "code_information": [{"code": "C2628", "type": "HCPCS"}, {"code": "771039612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3508.05, "maximum": 8965.02, "gross_charge": 9744.59, "discounted_cash": 12180.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3605.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3605.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3605.49, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7308.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7308.44, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 8965.02, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3508.05, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7308.44, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7-4 X 70MM GRAFT", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "771011617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1617.19, "maximum": 4132.82, "gross_charge": 4492.2, "discounted_cash": 5615.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1662.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1662.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1662.11, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3369.15, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3369.15, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4132.82, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1617.19, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3369.15, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7.0CM KOPANS HOOK LOCAL NEEDLE BR", "code_information": [{"code": "771027003", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 227.88, "discounted_cash": 284.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "7.5 HI-LO E VAC ET TUBS", "code_information": [{"code": "771024346", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 187.7, "discounted_cash": 234.63, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "72 IN HIGH PRESSURE LINE", "code_information": [{"code": "771039806", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 73.05, "discounted_cash": 91.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "72 INCH PRESSURE LINE 25/BX", "code_information": [{"code": "771018445", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 86.39, "discounted_cash": 107.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "7200 EXP FILTER", "code_information": [{"code": "771020433", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 86.39, "discounted_cash": 107.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "7200 FILTER", "code_information": [{"code": "771042161", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 85.69, "discounted_cash": 107.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "740 EXP FILTER", "code_information": [{"code": "771020409", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 88.48, "discounted_cash": 110.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "7710", "code_information": [{"code": "771013111", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 262.15, "discounted_cash": 327.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "7F BRITE TIP SHEATH", "code_information": [{"code": "771023381", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 341.42, "discounted_cash": 426.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "7FR AL1", "code_information": [{"code": "771019170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 816.21, "discounted_cash": 1020.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "7FR AL1 SH", "code_information": [{"code": "771019169", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 816.21, "discounted_cash": 1020.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "7FR AR 1 GUIDE", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771019098", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 138.59, "maximum": 354.18, "gross_charge": 384.98, "discounted_cash": 481.23, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 288.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 288.73, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 354.18, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 138.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 288.73, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7FR ARI SH", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771022042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 138.59, "maximum": 354.18, "gross_charge": 384.98, "discounted_cash": 481.23, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 288.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 288.73, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 354.18, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 138.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 288.73, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7FR ARROW TREROTOLA OTW PTD", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "771031241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1635.39, "maximum": 4179.34, "gross_charge": 4542.77, "discounted_cash": 5678.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1680.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1680.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1680.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3407.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3407.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4179.34, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", 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"standard_charge_dollar": 117.8, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 46.09, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 96.03, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "8F MACH 1 JR4", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771040375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 120.88, "maximum": 308.93, "gross_charge": 335.8, "discounted_cash": 419.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 124.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 124.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 124.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 251.85, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 251.85, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 308.93, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 120.88, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 251.85, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "8F MACH 1 JR4 SH", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771040374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 120.88, "maximum": 308.93, "gross_charge": 335.8, "discounted_cash": 419.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 124.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 124.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 124.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 251.85, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 251.85, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 308.93, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 120.88, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 251.85, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "8FR .86 90CM JR4", "code_information": [{"code": "771013865", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 944.36, "discounted_cash": 1180.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR AR1", "code_information": [{"code": "771013707", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 914.56, "discounted_cash": 1143.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR AR2", "code_information": [{"code": "771015890", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1015.88, "discounted_cash": 1269.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR BRITE TIP 55 CM", "code_information": [{"code": "771023445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.15, "discounted_cash": 692.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR BRITE TIP 90 CM", "code_information": [{"code": "771023444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 759.59, "discounted_cash": 949.49, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR CLOSED SUCTION CATHETER", "code_information": [{"code": "771041669", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 94.12, "discounted_cash": 117.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR FEEDING TUBE", "code_information": [{"code": "771004567", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 86.39, "discounted_cash": 107.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR FEEDING TUBES", "code_information": [{"code": "731060000", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.06, "discounted_cash": 3.83, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR FL4 W/SIDE HOLES", "code_information": [{"code": "771008864", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 977.94, "discounted_cash": 1222.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR JL4", "code_information": [{"code": "771019182", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1042.59, "discounted_cash": 1303.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR JL4 GUIDING CATHETER", "code_information": [{"code": "771012942", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1988.25, "discounted_cash": 2485.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR JR4", "code_information": [{"code": "771013399", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 914.56, "discounted_cash": 1143.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR JR4", "code_information": [{"code": "771019186", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 993.53, "discounted_cash": 1241.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR JR4 SH", "code_information": [{"code": "771019187", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 993.53, "discounted_cash": 1241.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR JR4 VIKING", "code_information": [{"code": "771021358", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 838.55, "discounted_cash": 1048.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR JR4 WITH SH", "code_information": [{"code": "771012732", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 984.98, "discounted_cash": 1231.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR JR4 WITH SIDE HOLES (WISEGUID", "code_information": [{"code": "771017438", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 857.95, "discounted_cash": 1072.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR JR5 .086 100CM", "code_information": [{"code": "771015655", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 957.71, "discounted_cash": 1197.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR LCB8FR LCB", "code_information": [{"code": "771019185", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.83, "discounted_cash": 1317.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR MACH 1 CLS 4", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039491", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 232.17, "maximum": 593.34, "gross_charge": 644.94, "discounted_cash": 806.18, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 483.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 483.7, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 593.34, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 232.17, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 483.7, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "8FR MACH 1 FL 4 SH", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771039488", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 126.96, "maximum": 324.45, "gross_charge": 352.67, "discounted_cash": 440.84, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 264.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 264.5, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 324.45, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 126.96, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 264.5, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "8FR MPA1 GUIDING CATHETER", "code_information": [{"code": "771013718", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 957.71, "discounted_cash": 1197.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR PV MACH 1 LIMA", "code_information": [{"code": "771039460", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 823.66, "discounted_cash": 1029.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR Q3.5 WITH OUT SIDE HOLES", "code_information": [{"code": "771017775", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 845.86, "discounted_cash": 1057.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR Q4 WISEGUIDE", "code_information": [{"code": "771017376", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 889.42, "discounted_cash": 1111.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR RCB GUIDING CATHETER", "code_information": [{"code": "771013717", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1105.82, "discounted_cash": 1382.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR RDC", "code_information": [{"code": "771016117", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.83, "discounted_cash": 1317.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR SL4 GUIDING CATHETER", "code_information": [{"code": "771012948", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1875.26, "discounted_cash": 2344.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8FR VISTABRITE TIP RDC GUIDE CATH", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771031366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 365.71, "maximum": 934.6, "gross_charge": 1015.88, "discounted_cash": 1269.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 375.87, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 375.87, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 375.87, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 761.91, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 761.91, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 934.6, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 365.71, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 761.91, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "8FR XB4", "code_information": [{"code": "771019180", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 993.53, "discounted_cash": 1241.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8G 12CM MAMMOTOME PROBE", "code_information": [{"code": "771042002", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1398.08, "discounted_cash": 1747.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8G BIOPSY KIT BOWTIE ID", "code_information": [{"code": "771042005", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 734.86, "discounted_cash": 918.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8G DISPOSABLE PROBE FORKSHAPE", "code_information": [{"code": "771042004", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 67.42, "discounted_cash": 84.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8G DISPOSABLE PROBE GUIDE", "code_information": [{"code": "771019717", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 83.43, "discounted_cash": 104.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8G MAMMOTONE PROBE", "code_information": [{"code": "771019713", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2883.59, "discounted_cash": 3604.49, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8G MARKERS", "code_information": [{"code": "771042110", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 726.43, "discounted_cash": 908.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8G/115 TARGET SET", "code_information": [{"code": "771042117", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1434.62, "discounted_cash": 1793.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8G/145 TARGET SET", "code_information": [{"code": "771042116", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1434.62, "discounted_cash": 1793.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8MM CURVED TIP 611", "code_information": [{"code": "771003149", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.23, "discounted_cash": 54.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "8X17 JACK FROST GEL PACK", "code_information": [{"code": "771013857", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 52.09, "discounted_cash": 65.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "9 EM CORE SESSIONS", "code_information": [{"code": "G9875", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9 FR VISTABRIK TIP RDC 1 CATH", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771031363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.92, "maximum": 981.14, "gross_charge": 1066.46, "discounted_cash": 1333.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 394.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 394.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 394.59, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 799.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 799.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 981.14, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 383.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 799.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9 FR VISTABRITE TIP RDC CATH", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771031364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.92, "maximum": 981.14, "gross_charge": 1066.46, "discounted_cash": 1333.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 394.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 394.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 394.59, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 799.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 799.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 981.14, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 383.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 799.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9 X 40 X 120 SMART CONTROL", "code_information": [{"code": "C1877", "type": "HCPCS"}, {"code": "771024250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3839.38, "maximum": 9811.77, "gross_charge": 10664.97, "discounted_cash": 13331.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3946.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3946.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3946.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7998.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7998.72, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9811.77, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3839.38, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7998.72, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9F VISTA BRITE TIP INTRO GUIDE", "code_information": [{"code": "771024197", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1119.87, "discounted_cash": 1399.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "9FR INTRODUCER", "code_information": [{"code": "771012194", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 113.22, "discounted_cash": 141.53, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "9FR INTRODUCER KIT", "code_information": [{"code": "771002848", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 567.65, "discounted_cash": 709.56, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "9MM CURVED TIP CURETTE 612", "code_information": [{"code": "771003151", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.23, "discounted_cash": 54.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "9MM MEDIUM HEAL LIFTS", "code_information": [{"code": "771015561", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 58.14, "discounted_cash": 72.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "9MM STRAIGHT CURETTE", "code_information": [{"code": "771011499", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 34.24, "discounted_cash": 42.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "9VHPV VACCINE 2/3 DOSE IM", "code_information": [{"code": "90651", "type": "CPT"}], "standard_charges": [{"minimum": 61.03, "maximum": 301.92, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 301.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9VHPV VACCINE 2/3 DOSE IM", "code_information": [{"code": "90651", "type": "CPT"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9VHPV VACCINE 2/3 DOSE IM", "code_information": [{"code": "90651", "type": "CPT"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "<50% TOTAL PT OUTPT RA ENCTS", "code_information": [{"code": "M1008", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "<6YR NEW ONSET HD ACHE", "code_information": [{"code": "G2193", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">55 YRS TEMP HD ACHE", "code_information": [{"code": "G2192", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED NOT ORD", "code_information": [{"code": "G9368", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED ORD", "code_information": [{"code": "G9367", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=2 SAME HI-RSK MED W/O DIAG", "code_information": [{"code": "M1209", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=2 SAME MEDS TBL4 NOT ORD", "code_information": [{"code": "M1210", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=50% TOTAL PT OUTPT RA ENCT", "code_information": [{"code": "M1007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed 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"billing_class": "facility"}]}, {"description": "AAA TRI LOBE BALLOON", "code_information": [{"code": "771029056", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2727.19, "discounted_cash": 3408.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA TRUNK LIMB", "code_information": [{"code": "771031990", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43411.67, "discounted_cash": 54264.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA TRUNK LIMB", "code_information": [{"code": "771032822", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 57873.35, "discounted_cash": 72341.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA TRUNK LIMB WL", "code_information": [{"code": "771032413", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43413.07, "discounted_cash": 54266.34, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA VANSHIE 5 CATH", "code_information": [{"code": "771026584", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 272.57, "discounted_cash": 340.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA VESSEL DIALATORS 20", "code_information": [{"code": "771025034", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 412.65, "discounted_cash": 515.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA VESSEL DIALATORS 22", "code_information": [{"code": "771025035", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 463.67, "discounted_cash": 579.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA VESSEL DIALATORS 24", "code_information": [{"code": "771025036", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 82.87, "discounted_cash": 103.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA WALT STENT", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "771025031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2369.38, "maximum": 6055.09, "gross_charge": 6581.63, "discounted_cash": 8227.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2435.2, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2435.2, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2435.2, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4936.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4936.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 6055.09, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2369.38, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4936.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AAA WIRE", "code_information": [{"code": "771021003", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 163.8, "discounted_cash": 204.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA WIRE .035 AMPLATZ", "code_information": [{"code": "771021001", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 612.61, "discounted_cash": 765.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAA WIRE COOK TSMG-35-260-LES", "code_information": [{"code": "771021055", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 963.9, "discounted_cash": 1204.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AAC NON-ELECTRONIC BOARD", "code_information": [{"code": "E1902", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AAPEX RX 2.25X15", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771030792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 453.22, "maximum": 1158.25, "gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.69, "maximum": 48.84, "estimated_discounted_cash": 11111.7, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 48.84, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 43.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 43.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 11111.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 11111.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABBI DRAPES STERILE 12/BX", "code_information": [{"code": "771018504", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.86, "discounted_cash": 41.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABBI SYSTEM INSTRU 20MM 3BX", "code_information": [{"code": "771018379", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3498.77, "discounted_cash": 4373.46, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABBI SYSTEM INSTRUMENT 10MM 3BX", "code_information": [{"code": "771018377", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3498.77, "discounted_cash": 4373.46, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABBI SYSTEM INSTRUMENT 15MM 3BX", "code_information": [{"code": "771018378", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3498.77, "discounted_cash": 4373.46, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABCIXIMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 976.5, "maximum": 976.5, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABCIXIMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0130", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABCIXIMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0130", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABD IMAG W/US, CT OR MRI", "code_information": [{"code": "G9455", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}], "standard_charges": [{"minimum": 865.08, "maximum": 2858.47, "estimated_discounted_cash": 1029.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2063.52, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 2858.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 2858.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2238.15, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_percentage": 75.0, "possible_amount": 724.58, "count": "1 through 10", "median_amount": 724.58, "methodology": "percent of total billed charges", "10th_percentile": 724.58, "90th_percentile": 724.58}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 724.58, "count": "1 through 10", "median_amount": 724.58, "methodology": "percent of total billed charges", "10th_percentile": 724.58, "90th_percentile": 724.58}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1468.27, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 936.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 865.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 936.42, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "704409611", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 452.12, "maximum": 2858.47, "gross_charge": 1888.48, "discounted_cash": 2360.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 452.12, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1246.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1246.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1246.39, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2063.52, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 2858.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 2858.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2238.15, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1416.36, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1416.36, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1468.27, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1737.4, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 936.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 452.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 865.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 936.42, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 679.85, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1416.36, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "801520012", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 43.85, "maximum": 2858.47, "gross_charge": 121.81, "discounted_cash": 152.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 452.12, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 80.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 80.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 80.39, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2063.52, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 2858.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 2858.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2238.15, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 91.35, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 91.35, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1468.27, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 112.06, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 936.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 452.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 865.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 936.42, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 43.85, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 91.35, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABDOMINAL AORTOGRAM W/BILATERAL RUNOFFS", "code_information": [{"code": "75630", "type": "CPT"}, {"code": "713550347", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 250.5, "maximum": 6074.02, "gross_charge": 3946.99, "discounted_cash": 4933.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2960.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2960.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6074.02, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3631.23, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1420.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2960.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABDOMINAL SHUNT/INJ", "code_information": [{"code": "49427", "type": "CPT"}, {"code": "704109620", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 235.21, "maximum": 601.1, "gross_charge": 653.37, "discounted_cash": 816.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 431.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 431.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 431.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 490.02, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 490.02, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 601.1, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 235.21, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 490.02, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABDOMINAL WOUND CLOSURE KIT", "code_information": [{"code": "771039112", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6659.48, "discounted_cash": 8324.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABDUCTION PILLOW MEDIUM SOLD", "code_information": [{"code": "771005015", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 10.52, "discounted_cash": 13.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABG - COHB", "code_information": [{"code": "82375", "type": "CPT"}, {"code": "701701275", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.95, "maximum": 120.19, "gross_charge": 130.65, "discounted_cash": 163.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 120.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 47.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABG - COHB", "code_information": [{"code": "82375", "type": "CPT"}, {"code": "701701276", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.95, "maximum": 120.19, "gross_charge": 130.65, "discounted_cash": 163.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 120.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 47.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABG - COHB", "code_information": [{"code": "82375", "type": "CPT"}, {"code": "701701286", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.95, "maximum": 120.19, "gross_charge": 130.65, "discounted_cash": 163.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 120.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 47.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABG - COHB", "code_information": [{"code": "82375", "type": "CPT"}, {"code": "701701322", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.95, "maximum": 120.19, "gross_charge": 130.65, "discounted_cash": 163.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 86.22, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 120.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 47.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABG - COHB", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "701701275", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 25.29, "maximum": 173.19, "gross_charge": 188.26, "discounted_cash": 235.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 173.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 67.77, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABG - COHB", "code_information": [{"code": "82805", "type": "CPT"}, {"code": "701701276", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 31.35, "maximum": 98.46, "gross_charge": 87.1, "discounted_cash": 108.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 57.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 57.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 57.48, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 65.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 65.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 98.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 80.13, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 82.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 76.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 82.71, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 31.35, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 65.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABG - COHB", "code_information": [{"code": "82805", "type": "CPT"}, {"code": "701701286", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 31.35, "maximum": 98.46, "gross_charge": 87.1, "discounted_cash": 108.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 57.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 57.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 57.48, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 65.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 65.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 98.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 80.13, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 82.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 76.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 82.71, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 31.35, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 65.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABI BILAT>3 LEV OR BILAT SGL LVL", "code_information": [{"code": "93923", "type": "CPT"}, {"code": "656030166", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 144.37, "maximum": 460.18, "gross_charge": 500.2, "discounted_cash": 625.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 330.13, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 330.13, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 330.13, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 375.15, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 375.15, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 253.01, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 460.18, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 156.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 144.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 156.27, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 180.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 375.15, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}], "standard_charges": [{"minimum": 145.04, "maximum": 375.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"minimum": 2636.93, "maximum": 3652.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2636.93, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3652.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3652.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2860.09, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}], "standard_charges": [{"minimum": 2636.93, "maximum": 3652.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2636.93, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3652.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3652.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2860.09, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}], "standard_charges": [{"minimum": 5957.63, "maximum": 21317.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 5957.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21317.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5957.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11872.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}], "standard_charges": [{"minimum": 6591.4, "maximum": 11587.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11587.76, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6591.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}], "standard_charges": [{"minimum": 590.42, "maximum": 6045.88, "estimated_discounted_cash": 2313.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 590.42, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4364.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6045.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6045.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 4733.87, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2470.19, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 590.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1366.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}], "standard_charges": [{"minimum": 155.69, "maximum": 2470.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 590.42, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2470.19, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 590.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1366.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}], "standard_charges": [{"minimum": 9473.03, "maximum": 16673.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 16673.19, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 10398.53, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9606.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 10398.53, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}], "standard_charges": [{"minimum": 5383.27, "maximum": 13122.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 9345.9, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5827.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5383.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5827.25, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATOR 90 DEGREE", "code_information": [{"code": "771026395", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1283.98, "discounted_cash": 1604.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABLATOR 90 HOOK", "code_information": [{"code": "771034645", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 789.66, "discounted_cash": 987.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABLATOR 90DEG", "code_information": [{"code": "771032447", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 977.94, "discounted_cash": 1222.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}], "standard_charges": [{"minimum": 1494.96, "maximum": 6045.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4364.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6045.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6045.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 4733.87, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1618.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1494.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1618.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}], "standard_charges": [{"minimum": 3533.22, "maximum": 5440.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3927.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 5440.72, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 5440.72, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 4260.04, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3824.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3533.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3824.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}], "standard_charges": [{"minimum": 9497.26, "maximum": 13155.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9497.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13155.98, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13155.98, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10301.02, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}], "standard_charges": [{"minimum": 8532.19, "maximum": 14921.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9497.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13155.98, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13155.98, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10301.02, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 14921.6, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 9235.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 8532.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 9235.87, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}], "standard_charges": [{"minimum": 1801.78, "maximum": 6780.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4894.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6780.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6780.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5308.79, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 3127.37, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1950.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1801.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1950.39, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}], "standard_charges": [{"minimum": 4894.56, "maximum": 10789.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4894.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6780.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6780.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5308.79, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 10789.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6396.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5908.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6396.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}], "standard_charges": [{"minimum": 1801.78, "maximum": 6780.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4894.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6780.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6780.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5308.79, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 3127.37, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1950.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1801.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1950.39, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 288.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 266.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 288.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 266.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABO RH BLOOD TYPING DOCD", "code_information": [{"code": "3293F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABO TYPE - CHRG ONLY - CHRG ONLY", "code_information": [{"code": "86900", "type": "CPT"}, {"code": "702503961", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.83, "maximum": 152.14, "gross_charge": 141.82, "discounted_cash": 177.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 93.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 93.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 93.6, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 9.83, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 106.36, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 106.36, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 152.14, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 130.47, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 51.05, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 106.36, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.51, "maximum": 12.33, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 12.33, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}], "standard_charges": [{"minimum": 1503.73, "maximum": 6818.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1503.73, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4922.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5338.67, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3175.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1503.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2933.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3175.65, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}], "standard_charges": [{"minimum": 1503.73, "maximum": 6818.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1503.73, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4922.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5338.67, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3175.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1503.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2933.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3175.65, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}], "standard_charges": [{"minimum": 4922.1, "maximum": 6818.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4922.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5338.67, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}], "standard_charges": [{"minimum": 4922.1, "maximum": 6818.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4922.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5338.67, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}], "standard_charges": [{"minimum": 4922.1, "maximum": 6818.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4922.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5338.67, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}], "standard_charges": [{"minimum": 4922.1, "maximum": 6818.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4922.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5338.67, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}], "standard_charges": [{"minimum": 4922.1, "maximum": 6818.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4922.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5338.67, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}], "standard_charges": [{"minimum": 4922.1, "maximum": 6818.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4922.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6818.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5338.67, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 280.67, "maximum": 2556.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1845.29, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 2556.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 2556.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2001.46, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 303.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 280.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 303.82, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [{"code": "770", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3124.16, "maximum": 10242.19, "estimated_discounted_cash": 33430.49, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3124.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8501.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10242.19, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10242.19, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 9218.05, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 9402.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6930.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3124.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6402.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6930.87, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 8581.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1983.61, "maximum": 11645.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1983.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7267.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8756.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8756.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7880.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11645.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6021.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1983.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5562.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6021.35, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7455.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABOSULTE PRO VASC 8X60X135", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "771030829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2045.14, "maximum": 5226.47, "gross_charge": 5680.95, "discounted_cash": 7101.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2101.95, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2101.95, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2101.95, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4260.71, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4260.71, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5226.47, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2045.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4260.71, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABOSULTE PRO10X40X135", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "771030834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2898.5, "maximum": 7407.29, "gross_charge": 8051.41, "discounted_cash": 10064.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2979.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2979.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2979.02, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6038.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6038.55, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7407.29, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2898.5, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6038.55, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABOVE KNEE SURGICAL STOCKING", "code_information": [{"code": "A4490", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABP RECORDING ONLY", "code_information": [{"code": "93786", "type": "CPT"}, {"code": "713030015", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 102.11, "maximum": 275.31, "gross_charge": 299.26, "discounted_cash": 374.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 197.51, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 197.51, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 197.51, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 102.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 102.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 102.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 102.11, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 224.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 224.44, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 206.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 275.31, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 107.73, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 224.44, 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"standard_charges": [{"minimum": 1501.14, "maximum": 3836.26, "gross_charge": 4169.85, "discounted_cash": 5212.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1542.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1542.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1542.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3127.38, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3127.38, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3836.26, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", 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"methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4496.48, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9367.67, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSOLUTE .035 6 X 60 X 135", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "771024307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4628.51, "maximum": 11828.42, "gross_charge": 12856.98, "discounted_cash": 16071.23, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4757.08, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4757.08, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": 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[{"minimum": 4761.04, "maximum": 12167.11, "gross_charge": 13225.12, "discounted_cash": 16531.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4893.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4893.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4893.29, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9918.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9918.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 12167.11, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", 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"C1876", "type": "HCPCS"}, {"code": "771027535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4761.04, "maximum": 12167.11, "gross_charge": 13225.12, "discounted_cash": 16531.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4893.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4893.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4893.29, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9918.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9918.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 12167.11, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4761.04, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9918.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSOLUTE STENT 9X100X80 .035", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "771027496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3779.19, "maximum": 9657.93, "gross_charge": 10497.75, "discounted_cash": 13122.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3884.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3884.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3884.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7873.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7873.31, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9657.93, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3779.19, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7873.31, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG <= 16 SUC PUMP", "code_information": [{"code": "K0744", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG >16<=48 SUC PUMP", "code_information": [{"code": "K0745", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG >48 SUC PUMP", "code_information": [{"code": "K0746", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORPT DRG > 48 SQ IN W/BDR", "code_information": [{"code": "A6256", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT CROWN PORC TO TITANIUM", "code_information": [{"code": "D6097", "type": "HCPCS"}], "standard_charges": [{"minimum": 1152.0, "maximum": 1152.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT RETAIN PORC TO TITANIUM", "code_information": [{"code": "D6195", "type": "HCPCS"}], "standard_charges": [{"minimum": 1263.0, "maximum": 1263.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1263.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT CROWN TITANIUM", "code_information": [{"code": "D6094", "type": "HCPCS"}], "standard_charges": [{"minimum": 1146.0, "maximum": 1146.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1146.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT RETAINER TITANI", "code_information": [{"code": "D6194", "type": "HCPCS"}], "standard_charges": [{"minimum": 1174.0, "maximum": 1174.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1174.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED CROWN", "code_information": [{"code": "D6058", "type": "HCPCS"}], "standard_charges": [{"minimum": 1130.0, "maximum": 1130.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1130.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6059", "type": "HCPCS"}], "standard_charges": [{"minimum": 1152.0, "maximum": 1152.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6060", "type": "HCPCS"}], "standard_charges": [{"minimum": 1086.0, "maximum": 1086.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6061", "type": "HCPCS"}], "standard_charges": [{"minimum": 1118.0, "maximum": 1118.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1118.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6062", "type": "HCPCS"}], "standard_charges": [{"minimum": 1152.0, "maximum": 1152.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6063", "type": "HCPCS"}], "standard_charges": [{"minimum": 1111.0, "maximum": 1111.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1111.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6064", "type": "HCPCS"}], "standard_charges": [{"minimum": 1116.0, "maximum": 1116.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1116.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6068", "type": "HCPCS"}], "standard_charges": [{"minimum": 1136.0, "maximum": 1136.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1136.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6069", "type": "HCPCS"}], "standard_charges": [{"minimum": 1152.0, "maximum": 1152.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6070", "type": "HCPCS"}], "standard_charges": [{"minimum": 1119.0, "maximum": 1119.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1119.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6071", "type": "HCPCS"}], "standard_charges": [{"minimum": 1136.0, "maximum": 1136.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1136.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6072", "type": "HCPCS"}], "standard_charges": [{"minimum": 1185.0, "maximum": 1185.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1185.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6073", "type": "HCPCS"}], "standard_charges": [{"minimum": 1150.0, "maximum": 1150.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1150.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6074", "type": "HCPCS"}], "standard_charges": [{"minimum": 1152.0, "maximum": 1152.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABX PRES W/IN 10 DYS OF SYMP", "code_information": [{"code": "G9505", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABX REG PRESCRIBED", "code_information": [{"code": "G9498", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AC BOOT", "code_information": [{"code": "771024211", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 653.37, "discounted_cash": 816.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AC5 WOUND SYSTEM", "code_information": [{"code": "A2020", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AC5 WOUND SYSTEM", "code_information": [{"code": "A2020", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AC5 WOUND SYSTEM", "code_information": [{"code": "A2020", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACAPELLA", "code_information": [{"code": "771024880", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 463.67, "discounted_cash": 579.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACAPELLA CHOICE NS", "code_information": [{"code": "771043336", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2069.49, "discounted_cash": 2586.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACAPatch, per square centimeter", "code_information": [{"code": "Q4325", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACBE BAGS W/TIPS", "code_information": [{"code": "771006551", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 44.65, "discounted_cash": 55.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACC KIT 6056 M", "code_information": [{"code": "771048682", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 248.69, "discounted_cash": 310.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCENT MODIFICATION (QTR HOUR)", "code_information": [{"code": "687263942", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 36.49, "discounted_cash": 45.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCESS 6057-58 STYLET KIT", "code_information": [{"code": "771036478", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 248.69, "discounted_cash": 310.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCESS KIT FOR HERO GRAFT", "code_information": [{"code": "C1892", "type": "HCPCS"}, {"code": "771034746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 942.38, "maximum": 2408.32, "gross_charge": 2617.74, "discounted_cash": 3272.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 968.56, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 968.56, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 968.56, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1963.3, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1963.3, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2408.32, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 942.38, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1963.3, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESS OF TRANSEP CYTOL SAMP", "code_information": [{"code": "D0486", "type": "HCPCS"}], "standard_charges": [{"minimum": 146.0, "maximum": 146.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 146.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESS STYLET KIT 58CM", "code_information": [{"code": "771037196", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 248.69, "discounted_cash": 310.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 5828.09, "maximum": 8073.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}], "standard_charges": [{"minimum": 4866.23, "maximum": 6740.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4866.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6740.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6740.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5278.07, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESSORY KIT SJ", "code_information": [{"code": "771031824", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 796.83, "discounted_cash": 996.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCOLADE CEMENTED HIP STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771030942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7166.86, "maximum": 18315.31, "gross_charge": 19907.95, "discounted_cash": 24884.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 7365.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 7365.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 7365.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 14930.96, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 14930.96, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 18315.31, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7166.86, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 14930.96, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCOMODATIVE FOOTWEAR", "code_information": [{"code": "L3020", "type": "HCPCS"}, {"code": "771023431", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 233.1, "maximum": 672.18, "gross_charge": 730.64, "discounted_cash": 913.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 270.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 270.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 270.33, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 547.98, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 547.98, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 672.18, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 252.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 233.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 252.33, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 263.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 547.98, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCU-CHECK GLUCOSE", "code_information": [{"code": "82962", "type": "CPT"}, {"code": "701101745", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.18, "maximum": 44.0, "gross_charge": 47.83, "discounted_cash": 59.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 31.56, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 31.56, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 31.56, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 35.87, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 35.87, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4.1, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 44.0, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3.44, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 17.21, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 35.87, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCUCATH ACE INTRAVASCULAR CATH", "code_information": [{"code": "771049043", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 462.85, "discounted_cash": 578.56, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCUDRAIN W/O ANTI REFLUX VALVE", "code_information": [{"code": "771037921", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1008.52, "discounted_cash": 1260.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCULINK 10-40", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "771030849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3686.11, "maximum": 9420.07, "gross_charge": 10239.21, "discounted_cash": 12799.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3788.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3788.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3788.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7679.4, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7679.4, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9420.07, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3686.11, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7679.4, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCULINK 6X30X132", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "771041684", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4452.98, "maximum": 11379.83, "gross_charge": 12369.39, "discounted_cash": 15461.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4576.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4576.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4576.67, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9277.04, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9277.04, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 11379.83, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4452.98, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9277.04, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCULINK 8x40x132", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "771043120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4256.71, "maximum": 10878.27, "gross_charge": 11824.21, "discounted_cash": 14780.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4374.95, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4374.95, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4374.95, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 8868.15, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8868.15, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 10878.27, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4256.71, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 8868.15, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCUSTICK II INTRO. SYSTEM", "code_information": [{"code": "771022074", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 911.89, "discounted_cash": 1139.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCUTRADE 2.0 DRIVER", "code_information": [{"code": "771026692", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.56, "discounted_cash": 1325.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCUTRAK 2 FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771026640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1193.28, "maximum": 3049.51, "gross_charge": 3314.69, "discounted_cash": 4143.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1226.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1226.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1226.43, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2486.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2486.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3049.51, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1193.28, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2486.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACDF PEEK 5D 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4053.01, "maximum": 10357.7, "gross_charge": 11258.37, "discounted_cash": 14072.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4165.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4165.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4165.59, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 8443.77, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8443.77, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 10357.7, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4053.01, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 8443.77, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE ARB ARNI", "code_information": [{"code": "G2092", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE BANDAGE 2\"", "code_information": [{"code": "771018523", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACE BANDAGE 4\"", "code_information": [{"code": "771018525", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 33.7, "discounted_cash": 42.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACE DISTAL SCR 14022-36 36MM", "code_information": [{"code": "771015995", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 150.46, "discounted_cash": 188.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACE END CAP 1505 CONSIGNMENT", "code_information": [{"code": "771015996", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 778.98, "discounted_cash": 973.73, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACE KIT SPACER", "code_information": [{"code": "771011425", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 90.88, "discounted_cash": 113.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACE TIBIAL NAIL 1510-28.5", "code_information": [{"code": "771015997", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3035.07, "discounted_cash": 3793.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACE WRAP 6X11 YDS", "code_information": [{"code": "771026512", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 39.32, "discounted_cash": 49.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACE-I/ARB RX", "code_information": [{"code": "M1200", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB NOT RX'D; DOC REAS", "code_information": [{"code": "G8474", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THERAPY RXD/TAKEN", "code_information": [{"code": "4010F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY FOR MOS/>", "code_information": [{"code": "4210F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY NOT RX'D", "code_information": [{"code": "G8475", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY RX'D", "code_information": [{"code": "G8473", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACESSO DL, PER SQ CM", "code_information": [{"code": "Q4293", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACESSO TL, PER SQ CM", "code_information": [{"code": "Q4300", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETABULAR AUGMENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771032996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5971.53, "maximum": 15260.6, "gross_charge": 16587.61, "discounted_cash": 20734.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 6137.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 6137.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 6137.41, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 12440.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 12440.7, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 15260.6, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5971.53, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 12440.7, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETABULAR CUP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771031793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5130.81, "maximum": 13112.07, "gross_charge": 14252.26, "discounted_cash": 17815.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5273.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5273.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5273.33, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 10689.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 10689.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 13112.07, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5130.81, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 10689.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETABULAR CUP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771032072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5074.67, "maximum": 12968.6, "gross_charge": 14096.31, "discounted_cash": 17620.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5215.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5215.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5215.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 10572.23, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 10572.23, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 12968.6, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5074.67, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 10572.23, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETABULAR CUP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771032076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5074.67, "maximum": 12968.6, "gross_charge": 14096.31, "discounted_cash": 17620.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5215.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5215.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5215.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 10572.23, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 10572.23, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 12968.6, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All 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"771032188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2397.71, "maximum": 6127.49, "gross_charge": 6660.32, "discounted_cash": 8325.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2464.31, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2464.31, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2464.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4995.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4995.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 6127.49, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2397.71, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4995.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETABULAR SHELL HEMI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771032531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3764.01, "maximum": 9619.14, "gross_charge": 10455.59, "discounted_cash": 13069.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3868.56, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3868.56, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3868.56, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7841.69, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7841.69, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9619.14, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3764.01, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7841.69, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETALULA SHELL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771025736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4316.9, "maximum": 11032.09, "gross_charge": 11991.41, "discounted_cash": 14989.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4436.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4436.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4436.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 8993.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8993.55, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 11032.09, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4316.9, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 8993.55, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETAMINOPHEN", "code_information": [{"code": "80329", "type": "CPT"}, {"code": "701101000", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 97.34, "maximum": 248.77, "gross_charge": 270.41, "discounted_cash": 338.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 178.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 178.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 178.47, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 202.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 202.8, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 248.77, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 97.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 202.8, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETATE CONC SOL PER GALLON", "code_information": [{"code": "A4708", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMID SODIUM INJECTIO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.88, "maximum": 29.9, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 29.9, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMID SODIUM INJECTIO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMID SODIUM INJECTIO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETUBULAR CUP 1217-20-056", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771025379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3707.35, "maximum": 9474.36, "gross_charge": 10298.22, "discounted_cash": 12872.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3810.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3810.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3810.34, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7723.66, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7723.66, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9474.36, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3707.35, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7723.66, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETUBULAR LINER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771026263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3681.56, "maximum": 9408.43, "gross_charge": 10226.56, "discounted_cash": 12783.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3783.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3783.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3783.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7669.92, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7669.92, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9408.43, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3681.56, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7669.92, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}], "standard_charges": [{"minimum": 11.92, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}], "standard_charges": [{"minimum": 17.85, "maximum": 28.94, "estimated_discounted_cash": 46.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}], "standard_charges": [{"minimum": 17.85, "maximum": 28.94, "estimated_discounted_cash": 46.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}], "standard_charges": [{"minimum": 11.69, "maximum": 28.94, "estimated_discounted_cash": 30.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7604", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0132", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.88, "maximum": 1.4, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.88, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0132", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0132", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7608", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.26, "maximum": 10.67, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 10.67, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7608", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7608", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACF DISTRACTION SCR 14MM R6398 5/", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771019274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.73, "maximum": 827.32, "gross_charge": 899.27, "discounted_cash": 1124.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 332.72, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 332.72, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 332.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 674.45, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 674.45, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 827.32, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 323.73, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 674.45, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACHALASIA BALLON 30MM/90FR", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "771040357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 707.16, "maximum": 1807.19, "gross_charge": 1964.34, "discounted_cash": 2455.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 726.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 726.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 726.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1473.25, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1473.25, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1807.19, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 707.16, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1473.25, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACHALASIA BALLOON 35MM/105FR", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "771040359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 707.16, "maximum": 1807.19, "gross_charge": 1964.34, "discounted_cash": 2455.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 726.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 726.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 726.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1473.25, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1473.25, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1807.19, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 707.16, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1473.25, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACHIEVE BX NEEDLE 14GX11", "code_information": [{"code": "771040148", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 554.15, "discounted_cash": 692.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACHILLES SPEEDBRIDGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771033233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5400.43, "maximum": 13801.11, "gross_charge": 15001.21, "discounted_cash": 18751.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5550.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5550.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5550.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 11250.9, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 11250.9, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 13801.11, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5400.43, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 11250.9, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACHILLES SPEEDBRIDGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771034675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2140.74, "maximum": 5470.78, "gross_charge": 5946.51, "discounted_cash": 7433.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2200.2, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2200.2, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2200.2, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4459.88, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4459.88, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5470.78, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2140.74, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4459.88, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACHILLES TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "771031611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4433.25, "maximum": 11329.42, "gross_charge": 12314.59, "discounted_cash": 15393.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4556.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4556.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4556.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9235.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9235.94, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 11329.42, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4433.25, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9235.94, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACHILLES TENDON 260MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "771038421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2935.67, "maximum": 7502.26, "gross_charge": 8154.64, "discounted_cash": 10193.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3017.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3017.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3017.21, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6115.98, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6115.98, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7502.26, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2935.67, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6115.98, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACHILLIES TENDON FROZEN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "771038515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2997.0, "maximum": 7659.01, "gross_charge": 8325.02, "discounted_cash": 10406.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3080.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3080.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3080.25, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6243.76, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6243.76, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7659.01, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2997.0, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6243.76, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACID CONC SOL PER GALLON", "code_information": [{"code": "A4709", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}], "standard_charges": [{"minimum": 489.58, "maximum": 893.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 577.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 800.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 800.55, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 626.82, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 893.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 529.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 489.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 529.96, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACL DISP PACK BONE TENDON BONE", "code_information": [{"code": "771039028", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1113.77, "discounted_cash": 1392.21, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACL DISPOSABLE PK BONE", "code_information": [{"code": "771039007", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1011.86, "discounted_cash": 1264.83, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACL GRAFT KNIFE 232110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771025666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 334.05, "maximum": 853.69, "gross_charge": 927.93, "discounted_cash": 1159.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 343.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 343.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 343.33, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 695.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 695.94, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 853.69, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 334.05, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 695.94, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACL KIT 232300", "code_information": [{"code": "771025621", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2498.3, "discounted_cash": 3122.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACL REOAR IMPLANT SYSTEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771038284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3415.42, "maximum": 8728.29, "gross_charge": 9487.28, "discounted_cash": 11859.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3510.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3510.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3510.29, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7115.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7115.46, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 8728.29, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3415.42, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7115.46, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACL SET ENDOSCOPIC FIXIATION", "code_information": [{"code": "771038316", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1362.34, "discounted_cash": 1702.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACL TIGHTROPE RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771042043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 649.5, "maximum": 1659.83, "gross_charge": 1804.17, "discounted_cash": 2255.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 667.54, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 667.54, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 667.54, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1353.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1353.12, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1659.83, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 649.5, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1353.12, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACMI ROUND TIP CATH 1805", "code_information": [{"code": "771005221", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 44.65, "discounted_cash": 55.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACN GRAFT SIZERS", "code_information": [{"code": "771022801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.85, "discounted_cash": 71.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}], "standard_charges": [{"minimum": 183.34, "maximum": 1084.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 783.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1084.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1084.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 849.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 324.28, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 198.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 183.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 198.46, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}], "standard_charges": [{"minimum": 144.37, "maximum": 260.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 260.45, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 156.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 144.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 156.27, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}], "standard_charges": [{"minimum": 36.22, "maximum": 66.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 66.87, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 39.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 36.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 39.21, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACP DISCUSS-NO DSCNMKR DOCD", "code_information": [{"code": "1124F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACP DISCUSS/DSCN MKR DOCD", "code_information": [{"code": "1123F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACP KIT SERIES I", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771037132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 287.79, "maximum": 735.46, "gross_charge": 799.42, "discounted_cash": 999.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 295.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 295.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 295.78, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 599.56, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 599.56, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 735.46, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 287.79, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 599.56, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACROBAT CALIBRATED TIP WIRE GUIDE", "code_information": [{"code": "771041698", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1237.91, "discounted_cash": 1547.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACROBAT CALIBRATED TIP WIRE GUIDE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771041292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 467.89, "maximum": 1195.74, "gross_charge": 1299.72, "discounted_cash": 1624.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 480.89, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 480.89, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 480.89, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 974.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 974.79, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1195.74, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 467.89, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 974.79, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACRONIZER 4MM", "code_information": [{"code": "771003632", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 866.95, "discounted_cash": 1083.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACRY SOF IQ TORIC IOL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "771030944", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 138.58, "maximum": 2647.47, "gross_charge": 2877.69, "discounted_cash": 3597.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1064.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1064.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1064.74, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2158.26, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2158.26, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 209.28, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2647.47, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 150.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 138.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 150.01, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1035.96, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2158.26, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACS 6F GUIDE AL 1.5", "code_information": [{"code": "771021318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6090.39, "discounted_cash": 7612.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS 8 SHMP", "code_information": [{"code": "771022204", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 838.55, "discounted_cash": 1048.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS BAL HVYWT GUIDE WIRE 190 CM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771019038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.91, "maximum": 646.34, "gross_charge": 702.55, "discounted_cash": 878.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 259.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 259.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 259.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 526.91, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 526.91, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 646.34, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 252.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 526.91, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACS BAL HVYWT GUIDE WIRE 300CM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771019039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.91, "maximum": 646.34, "gross_charge": 702.55, "discounted_cash": 878.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 259.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 259.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 259.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 526.91, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 526.91, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 646.34, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 252.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 526.91, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACS CROSS IT GUIDE WIRE 190CM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771019040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 401.13, "maximum": 1025.11, "gross_charge": 1114.25, "discounted_cash": 1392.81, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 412.27, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 412.27, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 412.27, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 835.68, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 835.68, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1025.11, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 401.13, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 835.68, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACS HI TORQUE BALANCE MIDDLEWEIGH", "code_information": [{"code": "771017436", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1184.09, "discounted_cash": 1480.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS HI-TORQUE IRON MAN 300CM", "code_information": [{"code": "771016809", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1184.09, "discounted_cash": 1480.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS OMNILINK 8 X 28", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "771022205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4256.2, "maximum": 10876.96, "gross_charge": 11822.79, "discounted_cash": 14778.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4374.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4374.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4374.43, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 8867.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8867.09, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 10876.96, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4256.2, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 8867.09, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACS PTCA PRIORITY PACK", "code_information": [{"code": "771004155", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 527.31, "discounted_cash": 659.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS RX LIFESTREAM 5.0 X 15", "code_information": [{"code": "771020474", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3851.74, "discounted_cash": 4814.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS STEELCORE 18, 190 CM", "code_information": [{"code": "771023390", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 947.32, "discounted_cash": 1184.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS VERIPATH 7FR LIMA", "code_information": [{"code": "771020465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1069.41, "discounted_cash": 1336.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS VERIPATH 7FR RDC 1", "code_information": [{"code": "771020467", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1069.41, "discounted_cash": 1336.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS VERIPATH 8FR LIMA", "code_information": [{"code": "771020466", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1069.41, "discounted_cash": 1336.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS WHISPER GUIDEWIRE 190 CM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771023213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 252.41, "maximum": 645.04, "gross_charge": 701.14, "discounted_cash": 876.43, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 525.85, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 525.85, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 645.04, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 252.41, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 525.85, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACS, .018 STEELCORE 18 LT", "code_information": [{"code": "771021372", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 819.16, "discounted_cash": 1023.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS, 8 FR AR1", "code_information": [{"code": "771022237", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 889.42, "discounted_cash": 1111.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS, 8 FR JL 4.0", "code_information": [{"code": "771022239", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 838.55, "discounted_cash": 1048.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS, 8 FR MP", "code_information": [{"code": "771022240", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 838.55, "discounted_cash": 1048.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACS, 8FR JCR 4 SH", "code_information": [{"code": 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{"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1932.75, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACT Z-BIOPSY, RENAL", "code_information": [{"code": "50200", "type": "CPT"}, {"code": "704203082", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 636.14, "maximum": 2626.08, "gross_charge": 2577.0, "discounted_cash": 3221.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 636.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1700.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1700.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1700.82, "methodology": "percent of total 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"plan_name": "PPO", "standard_charge_dollar": 2370.84, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1618.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 636.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1494.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1618.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 927.72, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1932.75, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACT Z-BIOPSY,ABDOMEN/RETROPERITONEAL", "code_information": [{"code": "704203077", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 977.94, "discounted_cash": 1222.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACT Z-PERC BILAIARY DRNG", "code_information": [{"code": "704203967", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2728.74, "discounted_cash": 3410.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}], "standard_charges": [{"minimum": 31.64, "maximum": 71.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 40.78, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 34.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 31.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 34.25, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}], "standard_charges": [{"minimum": 71.77, "maximum": 108.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 108.7, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 91.31, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 84.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 91.31, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}], "standard_charges": [{"minimum": 71.77, "maximum": 97.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 82.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 82.17, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTH, Plasma", "code_information": [{"code": "82024", "type": "CPT"}, {"code": "7014D6106", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 37.46, "maximum": 229.25, "gross_charge": 249.19, "discounted_cash": 311.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 164.46, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 164.46, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 164.46, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 186.89, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 186.89, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 48.28, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 229.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 40.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 37.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 40.55, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 89.7, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 186.89, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTICOAT 4X5 TAKE HOME", "code_information": [{"code": "A6197", "type": "HCPCS"}, {"code": "771030730", "type": "CDM"}, {"code": "623", "type": "RC"}], "standard_charges": [{"minimum": 22.29, "maximum": 213.26, "gross_charge": 231.81, "discounted_cash": 289.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 152.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 152.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 152.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 173.85, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 173.85, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 33.66, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 213.26, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 83.45, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 173.85, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTICOAT ABSORBENT", "code_information": [{"code": "771027237", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 114.77, "discounted_cash": 143.46, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACTICOAT7 4 X 5", "code_information": [{"code": "771027200", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 233.22, "discounted_cash": 291.53, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACTICOAT7 4 X 8", "code_information": [{"code": "771027199", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 148.91, "discounted_cash": 186.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACTIGRAPHY TESTING", "code_information": [{"code": "95803", "type": "CPT"}], "standard_charges": [{"minimum": 54.81, "maximum": 155.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 101.99, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 54.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}], "standard_charges": [{"minimum": 11.69, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIVATE MATRIX, PER SQ CM", "code_information": [{"code": "Q4301", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIVATED CARBON FILTER, EA", "code_information": [{"code": "A4680", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.43, "maximum": 139.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 139.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIVATED COAGULATION TIME", "code_information": [{"code": "85347", "type": "CPT"}, {"code": "701202010", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.15, "maximum": 120.21, "gross_charge": 130.67, "discounted_cash": 163.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 86.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 86.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 86.24, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 12.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 12.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12.95, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 98.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 98.0, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5.35, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 120.21, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4.49, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 47.04, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 98.0, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIVE LIFE ONE-PIECE DRAINABLE", "code_information": [{"code": "771010552", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.94, "discounted_cash": 22.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACTIVITY THERAPY, PER 15 MIN", "code_information": [{"code": "H2032", "type": "HCPCS"}], "standard_charges": [{"minimum": 105.75, "maximum": 146.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 105.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 146.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 146.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 114.7, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTRACTAIN CREAM", "code_information": [{"code": "771031017", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 75.98, "discounted_cash": 94.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACU CANCELLOUS SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771030064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 432.99, "maximum": 1106.54, "gross_charge": 1202.77, "discounted_cash": 1503.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 445.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 445.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 445.02, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 902.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 902.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1106.54, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 432.99, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 902.07, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACU PUNCH 3MM P325", "code_information": [{"code": "771025500", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.94, "discounted_cash": 22.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACUITY CUT AWAY GUIDE SYS", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771041685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2661.76, "maximum": 6802.28, "gross_charge": 7393.79, "discounted_cash": 9242.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2735.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2735.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2735.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 5545.34, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 5545.34, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 6802.28, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2661.76, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 5545.34, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUITY PRO 7F 60CM", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771048604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 427.08, "maximum": 1091.43, "gross_charge": 1186.34, "discounted_cash": 1482.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 438.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 438.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 438.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 889.75, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 889.75, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1091.43, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 427.08, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 889.75, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUITY PRO 9F 45CM", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771048600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 862.89, "maximum": 2205.17, "gross_charge": 2396.93, "discounted_cash": 2996.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 886.86, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 886.86, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 886.86, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1797.69, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1797.69, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2205.17, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 862.89, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1797.69, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUITY SPIRAL IS-1 UNI 80CM", "code_information": [{"code": "C1900", "type": "HCPCS"}, {"code": "771039856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7185.07, "maximum": 18361.85, "gross_charge": 19958.54, "discounted_cash": 24948.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 7384.65, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 7384.65, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 7384.65, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 14968.9, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 14968.9, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 18361.85, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7185.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 14968.9, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUITY SPIRAL LVA IS-1", "code_information": [{"code": "C1900", "type": "HCPCS"}, {"code": "771039633", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 7543.71, "maximum": 19278.38, "gross_charge": 20954.77, "discounted_cash": 26193.46, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 15716.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 15716.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 19278.38, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7543.71, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 15716.07, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUITY X4 SPIRAL 86CM", "code_information": [{"code": "C1900", "type": "HCPCS"}, {"code": "771048601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7879.42, "maximum": 20136.3, "gross_charge": 21887.29, "discounted_cash": 27359.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8098.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8098.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8098.29, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 16415.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 16415.46, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 20136.3, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7879.42, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 16415.46, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUMED PLATE SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771026977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1376.4, "maximum": 3517.48, "gross_charge": 3823.35, "discounted_cash": 4779.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1414.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1414.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1414.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2867.51, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2867.51, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3517.48, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1376.4, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2867.51, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUNED DRILL BIT", "code_information": [{"code": "771026551", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 796.69, "discounted_cash": 995.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACUNED DRILL BIT", "code_information": [{"code": "771026552", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 806.53, "discounted_cash": 1008.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL 15 MIN", "code_information": [{"code": "97810", "type": "CPT"}], "standard_charges": [{"minimum": 22.6, "maximum": 97.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL ADDL 15M", "code_information": [{"code": "97811", "type": "CPT"}], "standard_charges": [{"minimum": 70.56, "maximum": 97.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL 15 MIN", "code_information": [{"code": "97813", "type": "CPT"}], "standard_charges": [{"minimum": 22.6, "maximum": 97.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL ADDL 15M", "code_information": [{"code": "97814", "type": "CPT"}], "standard_charges": [{"minimum": 70.56, "maximum": 97.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [{"code": "880", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2803.35, "maximum": 11238.0, "estimated_discounted_cash": 25261.38, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 2803.35, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8724.52, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10511.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10511.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 9460.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11238.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6174.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2803.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5704.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6174.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7644.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [{"code": "289", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5567.94, "maximum": 22031.49, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 5567.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 18286.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 22031.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 22031.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 19828.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 17395.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 10156.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5567.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9382.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 10156.04, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 12574.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [{"code": "288", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11217.49, "maximum": 35208.01, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 11217.49, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 29223.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 35208.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 35208.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 31687.48, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 30525.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 17594.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 11217.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16253.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 17594.49, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 21783.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC", "code_information": [{"code": "290", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4754.43, "maximum": 14178.89, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 4754.43, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11768.66, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14178.89, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14178.89, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12761.11, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 12069.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6306.06, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 4754.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5825.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6306.06, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7807.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CHRONIC OBSTRUCT", "code_information": [{"code": "G9681", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CONGESTIVE HEART", "code_information": [{"code": "G9680", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE PNEUMONIA", "code_information": [{"code": "G9679", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE SKIN INFECTION", "code_information": [{"code": "G9682", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE URINARY TRACT INF", "code_information": [{"code": "G9684", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE FLUID/ELECTRO DISORDER", "code_information": [{"code": "G9683", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "835", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12709.8, "maximum": 27482.81, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 16010.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 22811.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 27482.81, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 27482.81, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 24734.74, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 26316.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 13758.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 16010.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 12709.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 13758.03, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 17033.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "834", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32032.94, "maximum": 71426.19, "estimated_discounted_cash": 64505.49, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 32032.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 59284.67, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 71426.19, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 71426.19, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 64284.12, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 65911.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 35603.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 32032.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 32890.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 35603.16, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 44080.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH OTHER PROCEDURES", "code_information": [{"code": "850", "type": "MS-DRG"}], "standard_charges": [{"minimum": 44075.35, "maximum": 73464.72, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 44075.35, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 59336.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 44075.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 54815.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 59336.89, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 73464.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "836", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6033.17, "maximum": 17898.48, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 6033.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14855.97, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17898.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17898.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 16108.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 14095.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8185.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 6033.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7561.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8185.0, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 10133.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC", "code_information": [{"code": "121", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3518.27, "maximum": 15082.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3518.27, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 10643.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 12822.89, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 12822.89, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 11540.7, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15082.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7492.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3518.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6921.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7492.56, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9276.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "122", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3294.08, "maximum": 9928.86, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3294.08, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8241.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9928.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9928.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8936.05, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8764.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4369.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3294.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4036.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4369.16, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5409.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [{"code": "281", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4526.76, "maximum": 12803.38, "estimated_discounted_cash": 43656.07, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 4526.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 10626.98, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 12803.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 12803.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 11523.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 10748.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5937.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 4526.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5485.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5937.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7351.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [{"code": "280", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5972.11, "maximum": 21551.76, "estimated_discounted_cash": 57800.78, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 5972.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17888.24, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 21551.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 21551.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 19396.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 18676.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 10572.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5972.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9767.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 10572.8, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 13090.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC", "code_information": [{"code": "282", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3865.03, "maximum": 9862.56, "estimated_discounted_cash": 44419.35, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3865.03, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8186.05, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9862.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9862.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8876.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8453.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4670.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3865.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4314.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4670.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5782.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [{"code": "284", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3598.09, "maximum": 10233.09, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3598.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8493.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10233.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10233.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 9209.86, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8708.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4773.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3598.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4409.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4773.03, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5909.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [{"code": "283", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10539.03, "maximum": 23207.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 10539.03, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 18961.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 22845.36, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 22845.36, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 20561.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 23207.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12595.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 10539.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11635.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12595.38, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 15594.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC", "code_information": [{"code": "285", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2725.88, "maximum": 7193.45, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 2725.88, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5970.66, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 7193.45, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 7193.45, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6474.16, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5753.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3616.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2725.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3340.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3616.16, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4477.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE NURSING FACILITY CARE", "code_information": [{"code": "G9685", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE PVD", "code_information": [{"code": "M1337", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE RENAL DIALYSIS PER HR/PORTI", "code_information": [{"code": "630113750", "type": "CDM"}, {"code": "801", "type": "RC"}], "standard_charges": [{"gross_charge": 1420.56, "discounted_cash": 1775.7, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "ACUTE RENAL DIALYSIS PER HR/PORTI", "code_information": [{"code": "657513750", "type": "CDM"}, {"code": "801", "type": "RC"}], "standard_charges": [{"gross_charge": 1420.56, "discounted_cash": 1775.7, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}], "standard_charges": [{"minimum": 685.59, "maximum": 2705.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 685.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 949.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 949.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 743.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2705.86, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1303.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1204.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1303.89, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE VITREOUS HEMORRHAGE", "code_information": [{"code": "M1333", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTRAK BONE SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771031768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 822.55, "maximum": 2102.08, "gross_charge": 2284.87, "discounted_cash": 2856.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 845.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 845.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 845.4, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1713.65, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1713.65, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2102.08, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 822.55, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1713.65, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTRAK SCREW MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771031943", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1075.62, "maximum": 2748.83, "gross_charge": 2987.86, "discounted_cash": 3734.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1105.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1105.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1105.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2240.89, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2240.89, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2748.83, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1075.62, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2240.89, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTRAK SCREWS MINI ALL SIZES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771026687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1193.28, "maximum": 3049.51, "gross_charge": 3314.69, "discounted_cash": 4143.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1226.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1226.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1226.43, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2486.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2486.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3049.51, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1193.28, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2486.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUVISION BLADE TIP", "code_information": [{"code": "771030002", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2665.52, "discounted_cash": 3331.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACVITY LDS", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771040121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3866.19, "maximum": 9880.27, "gross_charge": 10739.43, "discounted_cash": 13424.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3973.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3973.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3973.58, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 8054.57, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8054.57, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9880.27, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3866.19, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 8054.57, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0133", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.62, "estimated_discounted_cash": 78.12, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0133", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 78.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0133", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 78.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}], "standard_charges": [{"minimum": 16.0, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 20.61, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 17.31, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 17.31, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}], "standard_charges": [{"minimum": 16.36, "maximum": 33.14, "estimated_discounted_cash": 43.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADALIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0135", "type": "HCPCS"}], "standard_charges": [{"minimum": 976.5, "maximum": 2091.32, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2091.32, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADALIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0135", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADALIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0135", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT BARRIER STRIPS", "code_information": [{"code": "771023476", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 40.31, "discounted_cash": 50.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPT BEHAVIOR TX PHYS/QHP", "code_information": [{"code": "97155", "type": "CPT"}], "standard_charges": [{"minimum": 148.25, "maximum": 265.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 265.84, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 160.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 148.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 160.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT BHV TX EA 15 MIN", "code_information": [{"code": "373T", "type": "CPT"}], "standard_charges": [{"minimum": 27.49, "maximum": 29.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 27.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT CONVEX BARRIER RING - 20MM", "code_information": [{"code": "771024487", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 37.2, "discounted_cash": 46.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPT CONVEX BARRIER RING - 30MM", "code_information": [{"code": "771024483", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 40.72, "discounted_cash": 50.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPT CONVEX BARRIER RING - 40MM", "code_information": [{"code": "771024482", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 37.2, "discounted_cash": 46.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPT PASTE", "code_information": [{"code": "771023475", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 71.48, "discounted_cash": 89.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPT/EXT, PACING/NEURO LEAD", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT/EXT, PACING/NEURO LEAD", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT/EXT, PACING/NEURO LEAD", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTER CHECK FLO", "code_information": [{"code": "771034008", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 105.35, "discounted_cash": 131.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPTER FOR INJECTION 0.3CC", "code_information": [{"code": "771038004", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1955.71, "discounted_cash": 2444.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPTER FOR URETERAL CATH #140000", "code_information": [{"code": "771004802", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPTER LEAD", "code_information": [{"code": "771034333", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1701.6, "discounted_cash": 2127.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPTER POCHET MEDTR", "code_information": [{"code": "771031429", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4925.69, "discounted_cash": 6157.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPTER W/SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771032974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5133.84, "maximum": 13119.83, "gross_charge": 14260.69, "discounted_cash": 17825.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5276.45, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5276.45, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5276.45, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 10695.51, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 10695.51, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 13119.83, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5133.84, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 10695.51, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTER WYE", "code_information": [{"code": "771009170", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.94, "discounted_cash": 22.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPTION PL 12 HOLE/97 2.7 LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 539.52, "maximum": 1378.79, "gross_charge": 1498.69, "discounted_cash": 1873.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 554.51, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 554.51, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 554.51, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1124.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1124.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1378.79, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 539.52, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1124.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTIVE BEHAVIOR TX BY TECH", "code_information": [{"code": "97153", "type": "CPT"}], "standard_charges": [{"minimum": 85.35, "maximum": 148.63, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 148.63, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 92.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 85.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 92.39, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTOR 36MM REVERSE BODY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1743.22, "maximum": 4454.9, "gross_charge": 4842.29, "discounted_cash": 6052.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1791.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1791.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1791.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3631.71, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3631.71, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4454.9, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1743.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3631.71, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTOR PUMP IMMERSION DRAINAGE S", "code_information": [{"code": "771000810", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 35.81, "discounted_cash": 44.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPTOR SHORT WINGS", "code_information": [{"code": "771041365", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 605.58, "discounted_cash": 756.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPTOR SMR SHOULDER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 822.27, "maximum": 2101.36, "gross_charge": 2284.09, "discounted_cash": 2855.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 845.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 845.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 845.11, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1713.06, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1713.06, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2101.36, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 822.27, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1713.06, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTOR TAPER CONO ADATTATORE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 784.44, "maximum": 2004.69, "gross_charge": 2179.02, "discounted_cash": 2723.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 806.23, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 806.23, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 806.23, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1634.26, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1634.26, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2004.69, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 784.44, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1634.26, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTOR TUBING 18 GA 8208", "code_information": [{"code": "771016002", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADBAN BANDAGES", "code_information": [{"code": "771016046", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 40.31, "discounted_cash": 50.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADD 30 MINS COUNSEL", "code_information": [{"code": "G2080", "type": "HCPCS"}], "standard_charges": [{"minimum": 504.51, "maximum": 698.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 504.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 547.2, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD CLASP TO PARTIAL DENTURE", "code_information": [{"code": "D5660", "type": "HCPCS"}], "standard_charges": [{"minimum": 231.0, "maximum": 471.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 340.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 471.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 471.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 369.3, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD L 2ND ORDER 3RD ORDER B", "code_information": [{"code": "36248", "type": "CPT"}, {"code": "713550060", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 181.08, "maximum": 8073.31, "gross_charge": 503.02, "discounted_cash": 628.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 331.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 331.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 331.99, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 377.26, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 377.26, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 462.77, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 181.08, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 377.26, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD L 2ND ORDER 4RD ORDERB", "code_information": [{"code": "36251", "type": "CPT"}, {"code": "713550065", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1628.82, "maximum": 8073.31, "gross_charge": 4524.52, "discounted_cash": 5655.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2986.18, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2986.18, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2986.18, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3393.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3393.39, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5162.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4162.55, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1628.82, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3393.39, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD METAL SUB TO ACRYLC DENT", "code_information": [{"code": "D5876", "type": "HCPCS"}], "standard_charges": [{"minimum": 403.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 403.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD PROC CONSTRUCT NEW CROWN", "code_information": [{"code": "D2971", "type": "HCPCS"}], "standard_charges": [{"minimum": 218.0, "maximum": 1660.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD SATELLITE BAG - CHRG ONLY", "code_information": [{"code": "702503907", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 37.1, "discounted_cash": 46.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TOOTH TO PARTIAL DENTURE", "code_information": [{"code": "D5650", "type": "HCPCS"}], "standard_charges": [{"minimum": 198.0, "maximum": 471.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 340.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 471.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 471.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 369.3, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 198.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}], "standard_charges": [{"minimum": 145.59, "maximum": 919.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDITIVE FOR ENTERAL FORMULA", "code_information": [{"code": "B4104", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.06, "maximum": 0.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDL SEQ INFUSION UP TO 1HR", "code_information": [{"code": "96367", "type": "CPT"}, {"code": "670081053", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 65.67, "maximum": 319.28, "gross_charge": 347.05, "discounted_cash": 433.81, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 229.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 229.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 229.05, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 224.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 243.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 260.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 260.28, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 319.28, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 124.93, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 260.28, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDL SEQUENTIAL INFUSION", "code_information": [{"code": "96367", "type": "CPT"}, {"code": "600381053", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 65.67, "maximum": 356.76, "gross_charge": 387.79, "discounted_cash": 484.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 255.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 255.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 255.94, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 224.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 243.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 290.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 290.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 356.76, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 139.6, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 290.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDL SEQUENTIAL INFUSION", "code_information": [{"code": "96367", "type": "CPT"}, {"code": "601381053", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 65.67, "maximum": 335.69, "gross_charge": 364.89, "discounted_cash": 456.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 240.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 240.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 240.82, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 224.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 243.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 273.66, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 273.66, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 335.69, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}, {"payer_name": "Humana", 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"CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 65.67, "maximum": 390.75, "gross_charge": 424.73, "discounted_cash": 530.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 280.32, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 280.32, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 280.32, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 224.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 243.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 318.54, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 318.54, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 390.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 152.9, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 318.54, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDL SEQUENTIAL INFUSION", "code_information": [{"code": "96367", "type": "CPT"}, {"code": "663396702", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 65.67, "maximum": 356.76, "gross_charge": 387.79, "discounted_cash": 484.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 255.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 255.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 255.94, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 224.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 243.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 290.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 290.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 356.76, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 139.6, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 290.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDL SEQUENTIAL INFUSION", "code_information": [{"code": "96367", "type": "CPT"}, {"code": "665381053", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 65.67, "maximum": 356.76, "gross_charge": 387.79, "discounted_cash": 484.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 255.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 255.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 255.94, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 224.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 243.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 290.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 290.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 356.76, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 139.6, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 290.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDL SUPL MATRL&STAF TM PHE", "code_information": [{"code": "99072", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDT'L CLIENTS MANUALS", "code_information": [{"code": "771004189", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 55.19, "discounted_cash": 68.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADDT'L SECOND ORDERTHIRD O", "code_information": [{"code": "36218", "type": "CPT"}, {"code": "713550040", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 181.08, "maximum": 8073.31, "gross_charge": 503.02, "discounted_cash": 628.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 331.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 331.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 331.99, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 377.26, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 377.26, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 462.77, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 181.08, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 377.26, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDWIRE EXTENSION WIRE .014", "code_information": [{"code": "771024425", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2514.17, "discounted_cash": 3142.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADENOMA DETECTED SCREENING", "code_information": [{"code": "3775F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOMA NOT DETECT SCREENING", "code_information": [{"code": "3776F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOSINE INJ 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0153", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.64, "maximum": 0.64, "estimated_discounted_cash": 17.04, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.64, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOSINE INJ 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0153", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 17.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOSINE INJ 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0153", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 17.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}], "standard_charges": [{"minimum": 14.0, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}], "standard_charges": [{"minimum": 12.48, "maximum": 48.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 16.09, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 13.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 13.51, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}], "standard_charges": [{"minimum": 21.11, "maximum": 27.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 21.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}], "standard_charges": [{"minimum": 61.03, "maximum": 61.03, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}], "standard_charges": [{"minimum": 61.03, "maximum": 61.03, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHERE TX ASSESS AT LST ANN", "code_information": [{"code": "G8851", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}], "standard_charges": [{"minimum": 7239.26, "maximum": 10028.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7239.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10028.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10028.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7851.92, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESION BARRIER", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESION BARRIER", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESION BARRIER", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIVE BANDAGE, FIRST-AID", "code_information": [{"code": "A6413", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIVE MEDICAL SPRAY", "code_information": [{"code": "771029374", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 140.05, "discounted_cash": 175.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADIT MDD DYS REM 12 MNTHS", "code_information": [{"code": "G9509", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJ TRACH VALVE ONLY", "code_information": [{"code": "771019100", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1024.74, "discounted_cash": 1280.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADJ.GROOMING ACCESSORIES BRUSH", "code_information": [{"code": "771005883", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 369.37, "discounted_cash": 461.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}], "standard_charges": [{"minimum": 3153.25, "maximum": 11587.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3153.25, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5243.39, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 7263.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 7263.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5687.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11587.76, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3153.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6591.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUNCTIVE PROCEDURE", "code_information": [{"code": "D9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 4866.23, "maximum": 6740.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4866.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6740.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6740.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5278.07, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUST MAX PROST APPLIANCE", "code_information": [{"code": "D5992", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUST SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9948", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUSTABLE ALUM.CHILD CRUTCHES", "code_information": [{"code": "771015239", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 227.88, "discounted_cash": 284.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADJUSTABLE CHAIR FOR ESRD PT", "code_information": [{"code": "E1570", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUSTABLE CINCH STRAP", "code_information": [{"code": "771013557", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADJUSTABLE SWIVEL SPOON W/STOPS", "code_information": [{"code": "771002982", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 99.74, "discounted_cash": 124.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADJUSTMENT GASTRIC BAND", "code_information": [{"code": "S2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.69, "maximum": 155.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV HRMNL THXPY RXD", "code_information": [{"code": "4164F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV THXPYRXD/RCVD COLON CA", "code_information": [{"code": "4180F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV TRTMT CHEMO HER2", "code_information": [{"code": "G2206", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS NO RS 12 MO", "code_information": [{"code": "M1020", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS RS 12 PHQ<5", "code_information": [{"code": "M1019", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADLT DISP UND/PULL ON ABV XL", "code_information": [{"code": "T4544", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV CHEMO 1ST HOME VISIT", "code_information": [{"code": "G0090", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV DRUG 1ST HOME VISIT", "code_information": [{"code": "G0088", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV INFUSION DRUG IN HOME", "code_information": [{"code": "G0068", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM OF CHEMO DRUG IN HOME", "code_information": [{"code": "G0070", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM OF INFLUENZE VIRUS VAC", "code_information": [{"code": "800521153", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"gross_charge": 95.13, "discounted_cash": 118.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADM OF PNEUMOCOCCAL VAC", "code_information": [{"code": "800521152", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"gross_charge": 101.69, "discounted_cash": 127.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADM OF SOC DTR ASSESS 5-15 M", "code_information": [{"code": "G0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.49, "maximum": 29.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 27.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM SQ INFUSION DRUG IN HOME", "code_information": [{"code": "G0069", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM SUBQ DRUG 1ST HOME VISIT", "code_information": [{"code": "G0089", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 1ST", "code_information": [{"code": "M0249", "type": "HCPCS"}], "standard_charges": [{"minimum": 224.54, "maximum": 513.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 224.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 243.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 513.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 449.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 415.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 449.95, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 2ND", "code_information": [{"code": "M0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 224.54, "maximum": 513.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 224.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 311.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 243.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 513.57, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 449.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 415.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 449.95, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN ECG CONTRAST AGENT", "code_information": [{"code": "93352", "type": "CPT"}], "standard_charges": [{"minimum": 52.28, "maximum": 52.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 52.28, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "G0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.57, "maximum": 67.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN HOME SLEEP APNEA TEST", "code_information": [{"code": "D9956", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.12, "maximum": 103.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": 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"All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN OF INFLUENZA VIRUS VACCINE", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "600385000", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 40.46, "maximum": 103.4, "gross_charge": 112.4, "discounted_cash": 140.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 74.18, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 74.18, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 74.18, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 84.3, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 84.3, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 103.4, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 40.46, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 84.3, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN OF INFLUENZA VIRUS VACCINE", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "601385000", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 38.07, "maximum": 97.29, "gross_charge": 105.76, "discounted_cash": 132.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 97.29, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 38.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN OF INFLUENZA VIRUS VACCINE", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "601485000", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 38.07, "maximum": 97.29, "gross_charge": 105.76, "discounted_cash": 132.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 97.29, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 38.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN OF INFLUENZA VIRUS VACCINE", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "602385000", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 38.07, "maximum": 97.29, "gross_charge": 105.76, "discounted_cash": 132.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 97.29, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 38.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN OF INFLUENZA VIRUS VACCINE", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "603385000", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 38.07, "maximum": 97.29, "gross_charge": 105.76, "discounted_cash": 132.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 69.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 79.32, "methodology": "percent of total billed charges"}, {"payer_name": 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"plan_name": "PPO", "standard_charge_dollar": 784.05, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 961.76, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 376.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 784.05, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIRAL XTREME 7.0X80X130", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771042705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 376.34, "maximum": 961.76, "gross_charge": 1045.4, "discounted_cash": 1306.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 386.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 386.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 784.05, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 784.05, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 961.76, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 376.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 784.05, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIRAL XTREME 8.0X60X130", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771042706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 376.34, "maximum": 961.76, "gross_charge": 1045.4, "discounted_cash": 1306.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 386.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 386.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 784.05, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 784.05, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 961.76, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 376.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 784.05, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMISSION TO MCCM", "code_information": [{"code": "G9480", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ REMOV", "code_information": [{"code": "G9410", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ SURG REV", "code_information": [{"code": "G9412", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMN RSV MONOC ANTB IM CNSL", "code_information": [{"code": "96380", "type": "CPT"}], "standard_charges": [{"minimum": 31.62, "maximum": 31.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 31.62, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMN SARSCOV2 VACC 1 DOSE", "code_information": [{"code": "90480", "type": "CPT"}], "standard_charges": [{"minimum": 38.31, "maximum": 64.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 49.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 49.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 49.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 49.15, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 64.36, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 41.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 38.31, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 41.46, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADOPTIVE IMMUNOTHERAPY", "code_information": [{"code": "S2107", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADR DEP THRPY PRESCRIBED", "code_information": [{"code": "G9894", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}], "standard_charges": [{"minimum": 155.69, "maximum": 3656.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3656.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3377.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3656.51, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}], "standard_charges": [{"minimum": 983.24, "maximum": 3656.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 983.24, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1362.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1362.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1066.45, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3656.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3377.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3656.51, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13561.33, "maximum": 30539.35, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 17633.15, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 25348.06, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 30539.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 30539.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 27485.65, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 26515.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 14679.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 17633.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 13561.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 14679.79, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 18174.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8527.15, "maximum": 19175.17, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 11809.45, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 15915.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 19175.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 19175.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17257.8, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 17318.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 9230.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 11809.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 8527.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 9230.42, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 11428.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}], "standard_charges": [{"minimum": 640.11, "maximum": 2705.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 640.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1710.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 2369.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 2369.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1855.16, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2705.86, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1303.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 640.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1204.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1303.89, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENAL TISSUE TRANSPLANT", "code_information": [{"code": "S2103", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENALIN EPINEPHRINE INJECT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0171", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.62, "maximum": 0.92, "estimated_discounted_cash": 78.83, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 7.24, "count": "1 through 10", "median_amount": 7.24, "methodology": "percent of total billed charges", "10th_percentile": 7.24, "90th_percentile": 7.24}], "billing_class": "facility"}]}, {"description": "ADRENALIN EPINEPHRINE INJECT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0171", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 78.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 47.0, "possible_amount": 53.25, "count": "1 through 10", "median_amount": 13.03, "methodology": "percent of total billed charges", "10th_percentile": 13.03, "90th_percentile": 93.47}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 47.0, "possible_amount": 53.25, "count": "1 through 10", "median_amount": 13.03, "methodology": "percent of total billed charges", "10th_percentile": 13.03, "90th_percentile": 93.47}], "billing_class": "facility"}]}, {"description": "ADRENALIN EPINEPHRINE INJECT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0171", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 78.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 47.0, "possible_amount": 53.25, "count": "1 through 10", "median_amount": 13.03, "methodology": "percent of total billed charges", "10th_percentile": 13.03, "90th_percentile": 93.47}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 47.0, "possible_amount": 53.25, "count": "1 through 10", "median_amount": 13.03, "methodology": "percent of total billed charges", "10th_percentile": 13.03, "90th_percentile": 93.47}], "billing_class": "facility"}]}, {"description": "ADRIAMYCIN PER 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9000", "type": "HCPCS"}, {"code": "691061045", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.4, "maximum": 11.61, "gross_charge": 12.62, "discounted_cash": 15.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5.93, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9.46, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4.16, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 11.61, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9.46, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 1370.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1370.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1266.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1370.64, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADROIT 6F JR 4 SH", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771041360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 167.42, "maximum": 427.87, "gross_charge": 465.08, "discounted_cash": 581.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 427.87, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 167.42, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADROIT 6F JR4", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771041350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 167.42, "maximum": 427.87, "gross_charge": 465.08, "discounted_cash": 581.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 427.87, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 167.42, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADROIT 6F XB3.5", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771041349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 167.42, "maximum": 427.87, "gross_charge": 465.08, "discounted_cash": 581.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 427.87, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 167.42, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADROIT 6F XB4", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771041361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 167.42, "maximum": 427.87, "gross_charge": 465.08, "discounted_cash": 581.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 427.87, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 167.42, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADROIT 6F XBRCA", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771041363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 167.42, "maximum": 427.87, "gross_charge": 465.08, "discounted_cash": 581.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 172.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 427.87, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 167.42, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 348.81, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1034", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT NO 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1036", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT PD OUT MAT PR 180 DYS TX", "code_information": [{"code": "M1035", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT TKNG PHARMTHRY FOR OUD", "code_information": [{"code": "M1032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT AIR FLOW PRESSURE CANNULA", "code_information": [{"code": "771042183", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 23.87, "discounted_cash": 29.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER 15M", "code_information": [{"code": "S5135", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER DIEM", "code_information": [{"code": "S5136", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER DIEM", "code_information": [{"code": "S5102", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER HALF DAY", "code_information": [{"code": "S5101", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAYCARE SERVICES 15MIN", "code_information": [{"code": "S5100", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DIGNITY SIZE MED", "code_information": [{"code": "771000851", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 34.24, "discounted_cash": 42.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADULT DISP BRIEF/DIAP ABV XL", "code_information": [{"code": "T4543", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT FOSTER CARE PER DIEM", "code_information": [{"code": "S5140", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT FOSTER CARE PER MONTH", "code_information": [{"code": "S5141", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT NASAL AIR FLOW PRESSURE/GAS CANNUL", "code_information": [{"code": "771042182", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 23.87, "discounted_cash": 29.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADULT O2 SENSOR", "code_information": [{"code": "771025855", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.23, "discounted_cash": 54.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADULT PSYCH PRIVATE RB", "code_information": [{"code": "612510105", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 2620.55, "discounted_cash": 3275.69, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER LG", "code_information": [{"code": "T4523", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER MED", "code_information": [{"code": "T4522", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER SM", "code_information": [{"code": "T4521", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER XL", "code_information": [{"code": "T4524", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON LG", "code_information": [{"code": "T4527", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON MED", "code_information": [{"code": "T4526", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON SM", "code_information": [{"code": "T4525", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON XL", "code_information": [{"code": "T4528", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SPEECH AID", "code_information": [{"code": "D5953", "type": "HCPCS"}], "standard_charges": [{"minimum": 494.02, "maximum": 684.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 494.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 684.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 684.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 535.83, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT THERMISTOR", "code_information": [{"code": "771042180", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 598.56, "discounted_cash": 748.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADULT THERMOCAN CANNULA 7FT", "code_information": [{"code": "771042629", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.28, "discounted_cash": 40.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADULT TRACK MASK", "code_information": [{"code": "771007927", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADV CARE HEART DX MVP", "code_information": [{"code": "G0055", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV DEM CRGVR LIMITED", "code_information": [{"code": "G9917", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV RHEUM PT CARE MVP", "code_information": [{"code": "G0053", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCE 35LP 5X20X135", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771042058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 508.87, "maximum": 1300.46, "gross_charge": 1413.55, "discounted_cash": 1766.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 523.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 523.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 523.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1060.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1060.16, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1300.46, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 508.87, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1060.16, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCE 4.0X40 BALLOON", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771030270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 669.73, "maximum": 1711.54, "gross_charge": 1860.38, "discounted_cash": 2325.48, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1395.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1395.28, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1711.54, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 669.73, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1395.28, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCE 6X80 BALLOON", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771030273", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 669.73, "maximum": 1711.54, "gross_charge": 1860.38, "discounted_cash": 2325.48, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1395.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1395.28, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1711.54, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 669.73, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1395.28, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCE BILIARY BALLOON CATH 6MM/4CM", "code_information": [{"code": "771039324", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1535.99, "discounted_cash": 1919.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADVANCE CARE PLANNING EA ADDL 30 MINS", "code_information": [{"code": "99498", "type": "CPT"}, {"code": "656043126", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 80.25, "maximum": 205.08, "gross_charge": 222.92, "discounted_cash": 278.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 147.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 147.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 147.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 167.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 167.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 101.18, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 205.08, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 80.25, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 167.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCE CARE PLANNING FIRST 30 MINS", "code_information": [{"code": "99497", "type": "CPT"}, {"code": "656043120", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 80.25, "maximum": 205.08, "gross_charge": 222.92, "discounted_cash": 278.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 147.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 147.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 147.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 167.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 167.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 148.63, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 205.08, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 92.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 85.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 92.39, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 80.25, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 167.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCE RESP EVAL", "code_information": [{"code": "630113755", "type": "CDM"}, {"code": "222", "type": "RC"}], "standard_charges": [{"gross_charge": 296.47, "discounted_cash": 370.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADVANCED LIFE SUPPORT MILEAG", "code_information": [{"code": "A0390", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCED RESP EVALUATION", "code_information": [{"code": "632116000", "type": "CDM"}, {"code": "222", "type": "RC"}], "standard_charges": [{"gross_charge": 296.47, "discounted_cash": 370.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADVANCING CANCER CARE MVP", "code_information": [{"code": "M0001", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVISA SR MRI", "code_information": [{"code": "C1722", "type": "HCPCS"}, {"code": "771042331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9146.75, "maximum": 23375.03, "gross_charge": 25407.65, "discounted_cash": 31759.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 9400.83, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 9400.83, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 9400.83, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 19055.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 19055.73, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 23375.03, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9146.75, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 19055.73, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNC CARE PLAN IN RCRD", "code_information": [{"code": "1157F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNC CARE PLAN TLK DOCD", "code_information": [{"code": "1158F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEBD-10-4 BILIARY STENT", "code_information": [{"code": "771024164", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 922.01, "discounted_cash": 1152.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}], "standard_charges": [{"minimum": 115.13, "maximum": 523.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 115.13, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 159.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 159.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 124.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 523.36, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 287.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}], "standard_charges": [{"minimum": 115.13, "maximum": 523.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 115.13, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 159.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 159.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 124.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 523.36, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 287.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}], "standard_charges": [{"minimum": 72.11, "maximum": 159.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 115.13, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 159.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 159.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 124.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 72.11, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEP THRSHLD EST MLT FREQ I&R", "code_information": [{"code": "92652", "type": "CPT"}], "standard_charges": [{"minimum": 115.13, "maximum": 523.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 115.13, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 159.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 159.49, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 124.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 523.36, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 287.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEQUALIS CALOTTE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771031673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6765.72, "maximum": 17290.18, "gross_charge": 18793.68, "discounted_cash": 23492.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 6953.66, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 6953.66, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 6953.66, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 14095.26, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 14095.26, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 17290.18, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 6765.72, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 14095.26, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEQUALIS HUMERAL HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771030978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7982.79, "maximum": 20400.48, "gross_charge": 22174.44, "discounted_cash": 27718.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8204.54, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8204.54, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8204.54, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 16630.83, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 16630.83, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 20400.48, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7982.79, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 16630.83, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEQUALIS PRESS-FIT HUMERAL HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771030977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11386.65, "maximum": 29099.24, "gross_charge": 31629.61, "discounted_cash": 39537.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 11702.95, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 11702.95, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 11702.95, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 23722.2, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 23722.2, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 29099.24, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 11386.65, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 23722.2, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AERIDYAN MATRIX SM 3CC STER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1437.52, "maximum": 3673.67, "gross_charge": 3993.12, "discounted_cash": 4991.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1477.45, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1477.45, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1477.45, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2994.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2994.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3673.67, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1437.52, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2994.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEROBIC ADDITIONAL ID - CHG ONLY", "code_information": [{"code": "87077", "type": "CPT"}, {"code": "701904963", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.84, "maximum": 58.52, "gross_charge": 63.61, "discounted_cash": 79.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 41.98, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 41.98, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 41.98, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 47.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 47.7, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 10.1, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 58.52, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8.48, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 22.89, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 47.7, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEROCHAMBER PLUS", "code_information": [{"code": "771042189", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 58.99, "discounted_cash": 73.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AEROCHAMBER W/MASK,SMALL", "code_information": [{"code": "771022244", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 141.89, "discounted_cash": 177.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AEROGEN SOLO CONVENIENCE KIT", "code_information": [{"code": "771043337", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 907.68, "discounted_cash": 1134.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AEROSOL DRAINAGE SYSTEM", "code_information": [{"code": "771042162", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.83, "discounted_cash": 21.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}], "standard_charges": [{"minimum": 187.67, "maximum": 1034.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 746.85, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1034.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1034.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 810.05, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 355.64, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 203.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 187.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 203.14, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEROTECH 1", "code_information": [{"code": "771017763", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 202.58, "discounted_cash": 253.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}], "standard_charges": [{"minimum": 976.5, "maximum": 3275.6, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 3275.6, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 2869.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2651.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 2869.83, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFB CULTURE AND STAIN", "code_information": [{"code": "87116", "type": "CPT"}, {"code": "701904062", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.48, "maximum": 208.51, "gross_charge": 226.65, "discounted_cash": 283.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 149.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 149.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 149.58, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 169.98, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 169.98, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 208.51, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 10.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 81.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 169.98, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFB SMEAR - BENCH - CHRG ONLY", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "701904951", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.23, "maximum": 173.27, "gross_charge": 188.34, "discounted_cash": 235.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 124.3, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 124.3, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 124.3, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 141.25, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 141.25, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6.74, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 173.27, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 67.8, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 141.25, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFB STAIN", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "701904302", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.23, "maximum": 135.35, "gross_charge": 147.12, "discounted_cash": 183.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 97.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 97.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 97.09, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 110.34, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 110.34, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6.74, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 135.35, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 52.96, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 110.34, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 171.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 171.25, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 132.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}], "standard_charges": [{"minimum": 145.04, "maximum": 343.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 343.54, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 266.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFFINITI EH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771031471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7486.05, "maximum": 19131.02, "gross_charge": 20794.59, "discounted_cash": 25993.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 7693.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 7693.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 7693.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 15595.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 15595.94, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 19131.02, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7486.05, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 15595.94, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFFINITI GLENOID", "code_information": [{"code": "771031405", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17396.67, "discounted_cash": 21745.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFFINITI PEGGED GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771030976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.27, "maximum": 8572.03, "gross_charge": 9317.43, "discounted_cash": 11646.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3447.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3447.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3447.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6988.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6988.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 8572.03, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3354.27, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6988.07, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFFINITY 1.5 cm X 1.5 cm (per sq cm)", "code_information": [{"code": "Q4159", "type": "HCPCS"}, {"code": "771043348", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 352.92, "maximum": 2338.51, "gross_charge": 2541.86, "discounted_cash": 3177.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1194.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1194.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1194.67, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1906.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1906.39, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 352.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2338.51, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 915.06, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1906.39, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFFINITY 2.5 X 2.5 (per sq cm)", "code_information": [{"code": "Q4159", "type": "HCPCS"}, {"code": "771043347", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 352.92, "maximum": 6083.15, "gross_charge": 6612.13, "discounted_cash": 8265.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3107.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3107.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3107.7, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4959.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4959.09, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 352.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 6083.15, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2380.36, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4959.09, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFFIRM ACCESS PACK", "code_information": [{"code": "771042893", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4393.85, "discounted_cash": 5492.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFFIRM CANNULA PACK ULTRA", "code_information": [{"code": "771043325", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFFIRM CANNULA/ INTRODUCER", "code_information": [{"code": "771043032", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1164.84, "discounted_cash": 1456.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFFIRM CEMENT MIXER", "code_information": [{"code": "771043424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 514.25, "discounted_cash": 642.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFFIRM CEMENT/TRANSFER", "code_information": [{"code": "771043520", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 816.89, "discounted_cash": 1021.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFFIRM VCF ADD LEVEL KIT", "code_information": [{"code": "771043196", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5184.93, "discounted_cash": 6481.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFFIRM VCF KIT ISU ULTRA", "code_information": [{"code": "771042894", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 9923.05, "discounted_cash": 12403.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFFIRM VCF KIT ULTRA", "code_information": [{"code": "771043192", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 9921.65, "discounted_cash": 12402.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFFIRM VCF KIT ULTRA 20v", "code_information": [{"code": "771043308", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 12320.21, "discounted_cash": 15400.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}], "standard_charges": [{"minimum": 739.13, "maximum": 976.5, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 958.89, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 800.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 739.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 800.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFLURIA 5.0mL (MULTI-DOSE VIAL) 9yrs +", "code_information": [{"code": "800293009", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 65.56, "discounted_cash": 81.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFO INTERFACE", "code_information": [{"code": "L2820", "type": "HCPCS"}, {"code": "771029602", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 94.9, "maximum": 760.09, "gross_charge": 826.19, "discounted_cash": 1032.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 305.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 305.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 305.69, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 619.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 619.64, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 143.31, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 760.09, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 102.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 94.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 102.72, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 297.42, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 619.64, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}], "standard_charges": [{"minimum": 264.52, "maximum": 1514.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 264.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1093.24, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1514.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1514.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1185.76, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 941.51, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 547.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 264.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 506.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 547.93, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFTER YOUR HEART ATTACK-SPANISH", "code_information": [{"code": "771020892", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.94, "discounted_cash": 22.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFTERCARE WITH CC/MCC", "code_information": [{"code": "949", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5458.74, "maximum": 15153.97, "estimated_discounted_cash": 56685.84, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 5458.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12577.99, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 15153.97, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 15153.97, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13638.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 12197.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6950.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5458.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6420.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6950.19, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 8605.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITHOUT CC/MCC", "code_information": [{"code": "950", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3487.63, "maximum": 10458.0, "estimated_discounted_cash": 49583.75, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3825.99, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8680.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10458.0, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10458.0, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 9412.28, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 7395.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3775.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3825.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3487.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3775.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4674.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "560", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5468.85, "maximum": 14004.68, "estimated_discounted_cash": 39168.03, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 5468.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11624.07, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14004.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14004.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12604.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 13327.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7334.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5468.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6775.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7334.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9081.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "559", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11046.03, "maximum": 21858.58, "estimated_discounted_cash": 57652.16, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 12285.53, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 18142.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 21858.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 21858.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 19672.89, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21784.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 11957.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 12285.53, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11046.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 11957.04, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 14803.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "561", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3152.52, "maximum": 9895.06, "estimated_discounted_cash": 29386.44, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3152.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8213.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9895.06, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9895.06, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8905.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 9185.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5266.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3152.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4865.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5266.43, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 6520.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}], "standard_charges": [{"minimum": 11.62, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 14.98, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.51, "maximum": 248.83, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 248.83, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 223.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 206.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 223.25, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}], "standard_charges": [{"minimum": 6.77, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8.73, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGIL TRAC .035 8 X 40 X 80", "code_information": [{"code": "771024109", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1764.96, "discounted_cash": 2206.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AGILE INFLATION BALLOON 10X40", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771011766", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 477.51, "maximum": 1220.32, "gross_charge": 1326.44, "discounted_cash": 1658.05, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 994.83, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 994.83, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1220.32, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 477.51, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 994.83, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGILENT HEARTSTREAM PADS-ADULT", "code_information": [{"code": "771022085", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 283.8, "discounted_cash": 354.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AGILIS 8.5F 71CM MED CRL", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "771042248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1412.31, "maximum": 3609.26, "gross_charge": 3923.11, "discounted_cash": 4903.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1451.55, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1451.55, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1451.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2942.33, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2942.33, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3609.26, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1412.31, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2942.33, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGILITY 16 GUIDWIRE .016 205CM", "code_information": [{"code": "771023952", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1679.11, "discounted_cash": 2098.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AGILTRAC .035 8 X 40 X 80", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771024244", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 729.92, "maximum": 1865.37, "gross_charge": 2027.58, "discounted_cash": 2534.48, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1520.68, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1520.68, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1865.37, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 729.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1520.68, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGILTRAC .035 9 X 20 X 80", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771024012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 477.51, "maximum": 1220.32, "gross_charge": 1326.44, "discounted_cash": 1658.05, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 994.83, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 994.83, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1220.32, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 477.51, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 994.83, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGILTRAC 035 5X40X80", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771027665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 729.92, "maximum": 1865.37, "gross_charge": 2027.58, "discounted_cash": 2534.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 750.2, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 750.2, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 750.2, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1520.68, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1520.68, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1865.37, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 729.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1520.68, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AHI OR RDI INITIAL DX", "code_information": [{"code": "G8842", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}], "standard_charges": [{"minimum": 48.01, "maximum": 882.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 882.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 815.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 882.68, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 798.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 737.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI PSOR MRNA 50-100 GEN ALG", "code_information": [{"code": "258U", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 3858.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3858.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3564.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3858.75, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}], "standard_charges": [{"minimum": 145.04, "maximum": 399.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross 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combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 399.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 369.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 399.76, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD CHECK (DUAL)W/REPROG", "code_information": [{"code": "93283", "type": "CPT"}, {"code": "713030049", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 34.41, "maximum": 298.6, "gross_charge": 324.57, "discounted_cash": 405.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 214.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 214.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 214.21, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 243.42, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 243.42, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 61.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 298.6, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 34.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 116.84, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 243.42, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD CHECK (MULTI) W/REPROG", "code_information": [{"code": "93284", "type": "CPT"}, {"code": "713030050", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 34.41, "maximum": 350.3, "gross_charge": 380.77, "discounted_cash": 475.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 251.3, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 251.3, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 251.3, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 285.57, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 285.57, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 61.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 350.3, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 34.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 137.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 285.57, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD CHECK WITHOUT REPR", "code_information": [{"code": "93289", "type": "CPT"}, {"code": "713030052", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 34.41, "maximum": 226.19, "gross_charge": 245.86, "discounted_cash": 307.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 162.26, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 162.26, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 162.26, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 184.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 184.39, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 61.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 226.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 34.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 88.5, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 184.39, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD CHECK(SINGLE)W/REPROG", "code_information": [{"code": "93282", "type": "CPT"}, {"code": "713030039", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 34.41, "maximum": 241.72, "gross_charge": 262.74, "discounted_cash": 328.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 173.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 173.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 173.4, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 197.05, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 197.05, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 61.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 241.72, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 34.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 94.58, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 197.05, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD GENERATOR PROCEDURES", "code_information": [{"code": "245", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23731.03, "maximum": 70886.65, "estimated_discounted_cash": 135809.95, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 23731.03, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 58836.85, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 70886.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 70886.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 63798.53, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 53344.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 31477.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 23731.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 29079.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 31477.49, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 38972.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD LEAD PROCEDURES", "code_information": [{"code": "265", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17322.45, "maximum": 43394.74, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 17322.45, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 36018.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 43394.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 43394.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 39055.6, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 41603.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 22977.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 17322.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 21226.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 22977.52, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 28448.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, DUAL CHAMBER", "code_information": [{"code": "C1721", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, DUAL CHAMBER", "code_information": [{"code": "C1721", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, OTHER THAN SING/DUAL", "code_information": [{"code": "C1882", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, OTHER THAN SING/DUAL", "code_information": [{"code": "C1882", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, SINGLE CHAMBER", "code_information": [{"code": "C1722", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 42205.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, SINGLE CHAMBER", "code_information": [{"code": "C1722", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 42205.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR AMBULAN NONEMERG ROTARY", "code_information": [{"code": "S9961", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR AMBULANC NONEMERG FIXED", "code_information": [{"code": "S9960", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR CAST-RIGHT", "code_information": [{"code": "771010806", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 454.24, "discounted_cash": 567.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIR CONSTRAST ENEMA BAGS", "code_information": [{"code": "771007401", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 105.76, "discounted_cash": 132.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIR ELEVATOR FOR HEEL", "code_information": [{"code": "E0370", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR STIRRUP-UNIVERSAL", "code_information": [{"code": "771029408", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 210.04, "discounted_cash": 262.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIR STRIP POST OP DRESSING 10 1/4", "code_information": [{"code": "771008092", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 23.87, "discounted_cash": 29.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIR STRIP POST OP DRESSING 14 1/4", "code_information": [{"code": "771008093", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 22.62, "discounted_cash": 28.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIR STRIP POST OP DRESSING 7X3 1/", "code_information": [{"code": "771008091", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 20.9, "discounted_cash": 26.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIR/WATER AND SUCTION VALVE KIT", "code_information": [{"code": "771042075", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 53.37, "discounted_cash": 66.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRCAST-SMALL-LEFT", "code_information": [{"code": "771004705", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 317.24, "discounted_cash": 396.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRCAST-SMALL-RIGHT", "code_information": [{"code": "771004706", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 317.24, "discounted_cash": 396.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRCAST-STANDARD-LEFT", "code_information": [{"code": "771004703", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 337.2, "discounted_cash": 421.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRCAST-STANDARD-RIGHT", "code_information": [{"code": "771004702", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 317.24, "discounted_cash": 396.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRFIT F20 LARGE FFM", "code_information": [{"code": "771043162", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 212.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRFIT F20 MEDIUM FFM", "code_information": [{"code": "771043161", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 212.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRFIT F20 SMALL FFM", "code_information": [{"code": "771043160", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 212.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRFIT N10 SLM STANDARD", "code_information": [{"code": "771042172", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 51.97, "discounted_cash": 64.96, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRFIT N20 LARGE NASAL MASK", "code_information": [{"code": "771043165", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 130.65, "discounted_cash": 163.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRFIT N20 MEDIUM NASAL MASK", "code_information": [{"code": "771043164", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 130.65, "discounted_cash": 163.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRFIT N20 SMALL NASAL MASK", "code_information": [{"code": "771043163", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 130.65, "discounted_cash": 163.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRFLOW SENSOR", "code_information": [{"code": "771024617", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 66.99, "discounted_cash": 83.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRLIFE AEROSOL DRAINAGE", "code_information": [{"code": "771010021", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRSEAL 5/100 MM PORT", "code_information": [{"code": "771039107", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 587.79, "discounted_cash": 734.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRSEAL 8MM CANNULA CAP / OB", "code_information": [{"code": "771039108", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 649.8, "discounted_cash": 812.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRTRAQ LARYNGOSCOPE", "code_information": [{"code": "771026606", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 868.34, "discounted_cash": 1085.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY CUFFED OROPHANRGN 5Z10", "code_information": [{"code": "771020112", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 120.67, "discounted_cash": 150.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPHARYNGEAL 20FR 10/BX", "code_information": [{"code": "771019188", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 75.86, "discounted_cash": 94.83, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPHARYNGEAL 22 FR 10/BX", "code_information": [{"code": "771019189", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 81.88, "discounted_cash": 102.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY, NASO-PHARYNGEAL , 22 FR", "code_information": [{"code": "771023531", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 58.14, "discounted_cash": 72.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY, NASO-PHARYNGEAL, 24F", "code_information": [{"code": "771023530", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 61.8, "discounted_cash": 77.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY,N&P 36FR", "code_information": [{"code": "771004286", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 55.19, "discounted_cash": 68.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY,NASO-PHARYNGEAL 26FR", "code_information": [{"code": "771001086", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 55.19, "discounted_cash": 68.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY,NASO-PHARYNGEAL 28FR", "code_information": [{"code": "771001087", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 58.99, "discounted_cash": 73.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY,NASO-PHARYNGEAL 30FR", "code_information": [{"code": "771001088", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 55.19, "discounted_cash": 68.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY,NASO-PHARYNGEAL 32FR", "code_information": [{"code": "771001089", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 55.19, "discounted_cash": 68.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAY,NASO-PHARYNGEAL 34FR", "code_information": [{"code": "771001090", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 61.8, "discounted_cash": 77.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWY RESIST BY OSCILLOMETRY", "code_information": [{"code": "94728", "type": "CPT"}], "standard_charges": [{"minimum": 144.37, "maximum": 260.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 157.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 157.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 157.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 157.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 260.45, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 156.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 144.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 156.27, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG I: T1 MIC/T1A", "code_information": [{"code": "G9704", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG IB", "code_information": [{"code": "G9705", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 0 DOCD", "code_information": [{"code": "3370F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 1 DOCD", "code_information": [{"code": "3372F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 1 DOCD", "code_information": [{"code": "3374F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 2 DOCD", "code_information": [{"code": "3376F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 3 DOCD", "code_information": [{"code": "3378F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 4 DOCD", "code_information": [{"code": "3380F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 0 DOCD", "code_information": [{"code": "3382F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 1 DOCD", "code_information": [{"code": "3384F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 2 DOCD", "code_information": [{"code": "3386F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 3 DOCD", "code_information": [{"code": "3388F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 4 DOCD", "code_information": [{"code": "3390F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CNCR 0/IA MELAN DOCD", "code_information": [{"code": "3321F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC MEL CNR STG 0 - IIC", "code_information": [{"code": "G8944", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC STAGE DOCD B/4 THXPY", "code_information": [{"code": "3300F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC STG BRT CA DX II OR III", "code_information": [{"code": "G9831", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AKRA SKIN CLOSURE CORD", "code_information": [{"code": "771029930", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 231.81, "discounted_cash": 289.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AL3 GUIDER", "code_information": [{"code": "771018268", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 857.95, "discounted_cash": 1072.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALARM SYMP ASSESSED-1+ PRSNT", "code_information": [{"code": "1071F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALARM SYMP ASSESSED-ABSENT", "code_information": [{"code": "1070F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALATROFLOXACIN MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0200", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALATROFLOXACIN MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0200", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALATROFLOXACIN MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0200", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.58, "maximum": 3404.65, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2457.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2665.81, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 31.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 21.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 21.2, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 50ML", "code_information": [{"code": "P9047", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.62, "maximum": 3404.65, "estimated_discounted_cash": 694.67, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2457.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2665.81, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 79.62, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 302.52, "count": "1 through 10", "median_amount": 302.52, "methodology": "percent of total billed charges", "10th_percentile": 302.52, "90th_percentile": 302.52}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 50ML", "code_information": [{"code": "P9047", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 694.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 50ML", "code_information": [{"code": "P9047", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 694.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 5%, 250 ML", "code_information": [{"code": "P9045", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.98, "maximum": 3404.65, "estimated_discounted_cash": 371.69, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2457.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2665.81, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 79.62, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 53.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 48.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 53.01, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 5%, 250 ML", "code_information": [{"code": "P9045", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 371.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 5%, 250 ML", "code_information": [{"code": "P9045", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 371.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN),5%, 50ML", "code_information": [{"code": "P9041", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.92, "maximum": 3404.65, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2457.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2665.81, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN),5%, 50ML", "code_information": [{"code": "P9041", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN),5%, 50ML", "code_information": [{"code": "P9041", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}], "standard_charges": [{"minimum": 32.92, "maximum": 100.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 42.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 35.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 32.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 35.64, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN, BODY FLUID", "code_information": [{"code": "82042", "type": "CPT"}, {"code": "701101010", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.55, "maximum": 20.09, "gross_charge": 21.84, "discounted_cash": 27.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 14.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 14.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 14.41, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 16.38, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 16.38, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 20.09, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7.86, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 16.38, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN, PERICARDIAL", "code_information": [{"code": "82042", "type": "CPT"}, {"code": "7014D6295", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.55, "maximum": 24.38, "gross_charge": 26.5, "discounted_cash": 33.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 24.38, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN, PERITONEAL", "code_information": [{"code": "82042", "type": "CPT"}, {"code": "7014D6296", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.55, "maximum": 24.38, "gross_charge": 26.5, "discounted_cash": 33.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 24.38, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN, PLEURAL", "code_information": [{"code": "82042", "type": "CPT"}, {"code": "7014D6297", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.55, "maximum": 24.38, "gross_charge": 26.5, "discounted_cash": 33.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 24.38, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN, SERUM", "code_information": [{"code": "82040", "type": "CPT"}, {"code": "701101210", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.8, "maximum": 109.84, "gross_charge": 119.4, "discounted_cash": 149.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 78.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 78.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 78.8, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 89.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 89.55, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 109.84, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 42.98, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 89.55, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN, SYNOVIAL", "code_information": [{"code": "82042", "type": "CPT"}, {"code": "7014D6298", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.55, "maximum": 24.38, "gross_charge": 26.5, "discounted_cash": 33.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 17.49, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 24.38, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 19.87, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL", "code_information": [{"code": "691061040", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.78, "discounted_cash": 3.48, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7610", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7610", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7610", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7609", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.62, "maximum": 0.79, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7609", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7609", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL IPRATROP NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7620", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.62, "estimated_discounted_cash": 50.27, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_percentage": 75.0, "possible_amount": 63.26, "count": "1 through 10", "median_amount": 63.26, "methodology": "percent of total billed charges", "10th_percentile": 63.26, "90th_percentile": 63.26}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 63.26, "count": "1 through 10", "median_amount": 63.26, "methodology": "percent of total billed charges", "10th_percentile": 63.26, "90th_percentile": 63.26}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.23, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 7.26, "count": "1 through 10", "median_amount": 5.65, "methodology": "percent of total billed charges", "10th_percentile": 5.64, "90th_percentile": 11.3}], "billing_class": "facility"}]}, {"description": "ALBUTEROL IPRATROP NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7620", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 50.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL IPRATROP NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7620", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 50.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON COMPOUNDED", "code_information": [{"code": "800521165", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.26, "discounted_cash": 5.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7611", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.18, "maximum": 0.62, "estimated_discounted_cash": 59.84, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_percentage": 75.0, "possible_amount": 35.64, "count": "1 through 10", "median_amount": 46.28, "methodology": "percent of total billed charges", "10th_percentile": 9.45, "90th_percentile": 51.2}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 35.64, "count": "1 through 10", "median_amount": 46.28, "methodology": "percent of total billed charges", "10th_percentile": 9.45, "90th_percentile": 51.2}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.18, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 133.86, "count": "1 through 10", "median_amount": 133.86, "methodology": "percent of total billed charges", "10th_percentile": 133.86, "90th_percentile": 133.86}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7611", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 59.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7611", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 59.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7613", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.62, "estimated_discounted_cash": 93.12, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_percentage": 75.0, "possible_amount": 7.52, "count": "1 through 10", "median_amount": 7.52, "methodology": "percent of total billed charges", "10th_percentile": 7.52, "90th_percentile": 7.52}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 7.52, "count": "1 through 10", "median_amount": 7.52, "methodology": "percent of total billed charges", "10th_percentile": 7.52, "90th_percentile": 7.52}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_percentage": 36.0, "possible_amount": 2.41, "count": "1 through 10", "median_amount": 2.41, "methodology": "percent of total billed charges", "10th_percentile": 2.41, "90th_percentile": 2.41}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 16.43, "count": "1 through 10", "median_amount": 16.43, "methodology": "percent of total billed charges", "10th_percentile": 16.43, "90th_percentile": 16.43}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7613", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 93.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7613", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 93.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL (ETHANOL)", "code_information": [{"code": "80320", "type": "CPT"}, {"code": "701101215", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 107.84, "maximum": 275.59, "gross_charge": 299.56, "discounted_cash": 374.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 197.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 197.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 197.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 224.67, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 224.67, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 275.59, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 107.84, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 224.67, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG ASSESS", "code_information": [{"code": "H0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 261.1, "maximum": 361.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 261.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 361.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 361.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 283.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG HOTLINE", "code_information": [{"code": "H0030", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG INTERVEN", "code_information": [{"code": "H0022", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG OUTREACH", "code_information": [{"code": "H0023", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0024", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0025", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0026", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0027", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0028", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0029", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0002", "type": "HCPCS"}], "standard_charges": [{"minimum": 261.1, "maximum": 361.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 261.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 361.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 361.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 283.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0003", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.14, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0004", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0005", "type": "HCPCS"}], "standard_charges": [{"minimum": 201.09, "maximum": 278.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 201.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 278.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 278.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 218.11, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0006", "type": "HCPCS"}], "standard_charges": [{"minimum": 504.51, "maximum": 698.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 504.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 547.2, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0007", "type": "HCPCS"}], "standard_charges": [{"minimum": 170.74, "maximum": 236.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 170.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 236.52, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 236.52, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 185.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0008", "type": "HCPCS"}], "standard_charges": [{"minimum": 504.51, "maximum": 698.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 504.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 547.2, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0009", "type": "HCPCS"}], "standard_charges": [{"minimum": 504.51, "maximum": 698.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 504.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 698.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 547.2, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 579.8, "maximum": 803.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 579.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 628.87, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0011", "type": "HCPCS"}], "standard_charges": [{"minimum": 579.8, "maximum": 803.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 579.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 628.87, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0012", "type": "HCPCS"}], "standard_charges": [{"minimum": 579.8, "maximum": 803.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 579.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 628.87, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0013", "type": "HCPCS"}], "standard_charges": [{"minimum": 579.8, "maximum": 803.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 579.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 628.87, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0014", "type": "HCPCS"}], "standard_charges": [{"minimum": 135.66, "maximum": 187.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 135.66, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 187.93, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 187.93, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 147.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0015", "type": "HCPCS"}], "standard_charges": [{"minimum": 567.5, "maximum": 786.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 567.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 786.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 786.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 615.53, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0016", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.02, "maximum": 56.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 41.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 56.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 56.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 44.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0018", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.02, "maximum": 56.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 41.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 56.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 56.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 44.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0019", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0020", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.53, "maximum": 13.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9.53, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG TRAINING", "code_information": [{"code": "H0021", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL METABOLITE (EtG) (GUS)", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "LABGA6006", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 60.28, "maximum": 204.24, "gross_charge": 222.01, "discounted_cash": 277.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 146.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 146.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 146.52, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 166.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 166.5, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 77.68, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 204.24, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 60.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 79.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 166.5, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL METABOLITE (EtG) (I) (GUS)", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "LABGA6002", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 60.28, "maximum": 204.24, "gross_charge": 222.01, "discounted_cash": 277.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 146.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 146.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 146.52, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 166.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 166.5, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 77.68, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 204.24, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 60.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 79.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 166.5, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL OR PEROXIDE PER PINT", "code_information": [{"code": "A4244", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL WIPES PER BOX", "code_information": [{"code": "A4245", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [{"code": "895", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1716.16, "maximum": 18939.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1716.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14355.27, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17295.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17295.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 15565.84, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 18939.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 9326.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1716.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 8615.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 9326.4, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 11546.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5067.32, "maximum": 21265.74, "estimated_discounted_cash": 38213.68, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 5067.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17650.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 21265.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 21265.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 19139.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 20932.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 11470.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5067.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 10596.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 11470.73, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 14201.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [{"code": "897", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2156.73, "maximum": 10265.59, "estimated_discounted_cash": 17839.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 2156.73, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8520.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10265.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10265.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 9239.11, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 10072.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5682.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2156.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5249.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5682.54, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7035.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1992.31, "maximum": 6816.42, "estimated_discounted_cash": 13805.65, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1992.31, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5657.72, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6816.42, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6816.42, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6134.83, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6763.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4020.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1992.31, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3713.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4020.03, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4977.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG ABUSE SVC NOS", "code_information": [{"code": "H0047", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SCREENING", "code_information": [{"code": "H0049", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SERVICE 15 MIN", "code_information": [{"code": "H0050", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUB MISUSE ASSESS", "code_information": [{"code": "G2011", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.6, "maximum": 42.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 42.56, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV 15-30MN", "code_information": [{"code": "G0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.49, "maximum": 41.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 41.01, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 27.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV >30 MIN", "code_information": [{"code": "G0397", "type": "HCPCS"}], "standard_charges": [{"minimum": 148.25, "maximum": 227.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 227.87, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 160.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 148.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 160.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBSTANCE ABUSE SKIL", "code_information": [{"code": "T1012", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 3/MORE", "code_information": [{"code": "80322", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCON 30 DEGREE KELMAN", "code_information": [{"code": "771025143", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 659.81, "discounted_cash": 824.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALCON BIPOLAR BRUSH", "code_information": [{"code": "771021504", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 145.96, "discounted_cash": 182.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALCON TURBO SONICS", "code_information": [{"code": "771018005", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1721.83, "discounted_cash": 2152.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALD BLU TOOTH FM/DM RECEIVER", "code_information": [{"code": "V5286", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM ADAPT/BOOT COUPLIN", "code_information": [{"code": "V5289", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM AUD INPUT RECEIVER", "code_information": [{"code": "V5285", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM EAR LEVEL RECEIVER", "code_information": [{"code": "V5284", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM RECEIVER, NOS", "code_information": [{"code": "V5287", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM SYSTEM BINAURAL", "code_information": [{"code": "V5282", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM SYSTEM, MONAURAL", "code_information": [{"code": "V5281", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM TRANSMITTER ALD", "code_information": [{"code": "V5288", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FOR COCHLEAR IMPLANT", "code_information": [{"code": "V5273", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD NECK, LOOP IND RECEIVER", "code_information": [{"code": "V5283", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD TELEPHONE AMPLIFIER", "code_information": [{"code": "V5268", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD TRANSMITTER MICROPHONE", "code_information": [{"code": "V5290", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD UNSPECIFIED", "code_information": [{"code": "V5274", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD, TV AMPLIFIER, ANY TYPE", "code_information": [{"code": "V5270", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD, TV CAPTION DECODER", "code_information": [{"code": "V5271", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}], "standard_charges": [{"minimum": 976.5, "maximum": 5294.79, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 976.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4495.02, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5294.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4891.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5294.79, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}], "standard_charges": [{"minimum": 71.77, "maximum": 156.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 156.88, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 131.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 121.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 131.78, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALEFACEPT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0215", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.75, "maximum": 69.75, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 69.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 69.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 69.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 69.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALEFACEPT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0215", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALEFACEPT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0215", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALERT DEVICE, NOC", "code_information": [{"code": "A9280", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALERTING DEVICE, ANY TYPE", "code_information": [{"code": "V5269", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGINATE 4X4 5/BX", "code_information": [{"code": "771019767", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 75.86, "discounted_cash": 94.83, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALGINATE DRESSING > 48 SQ IN", "code_information": [{"code": "A6198", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0205", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.69, "maximum": 30.69, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0205", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0205", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCOSIDASE ALFA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.51, "maximum": 139.51, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCOSIDASE ALFA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0220", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCOSIDASE ALFA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0220", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALIGN RADIAL HEAD & LOCK SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771035484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4342.7, "maximum": 11098.02, "gross_charge": 12063.07, "discounted_cash": 15078.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4463.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4463.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4463.33, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9047.3, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9047.3, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 11098.02, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4342.7, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9047.3, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALIGN TO TRANS OBTURATOR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "771030891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1798.78, "maximum": 4596.89, "gross_charge": 4996.62, "discounted_cash": 6245.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1848.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1848.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1848.74, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3747.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3747.46, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4596.89, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1798.78, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3747.46, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALIQUOTING BLOOD", "code_information": [{"code": "86985", "type": "CPT"}, {"code": "702503272", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.48, "maximum": 203.43, "gross_charge": 29.13, "discounted_cash": 36.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 19.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 19.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 19.22, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 21.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 21.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 203.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 26.79, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 158.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 10.48, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 21.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALIQUOTING BLOOD - CHRG ONLY", "code_information": [{"code": "86985", "type": "CPT"}, {"code": "702503901", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 80.19, "maximum": 204.94, "gross_charge": 222.77, "discounted_cash": 278.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 147.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 147.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 147.02, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 167.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 167.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 203.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 204.94, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 158.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 80.19, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 167.07, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALK REARRANGEMENT", "code_information": [{"code": "701305509", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 556.45, "discounted_cash": 695.56, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALKALINE PHOSPHATASE", "code_information": [{"code": "84075", "type": "CPT"}, {"code": "701101220", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.02, "maximum": 131.92, "gross_charge": 143.4, "discounted_cash": 179.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 94.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 94.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 94.64, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 107.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 107.55, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 131.92, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 51.62, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 107.55, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALL POLY PAT VE 29 MM DIA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771038214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 954.85, "maximum": 2440.18, "gross_charge": 2652.38, "discounted_cash": 3315.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2440.18, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 954.85, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALL POLY PAT VE 32MM DIA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771038180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 954.85, "maximum": 2440.18, "gross_charge": 2652.38, "discounted_cash": 3315.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2440.18, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 954.85, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALL POLY PAT VE 35MM DIA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771038213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 954.85, "maximum": 2440.18, "gross_charge": 2652.38, "discounted_cash": 3315.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2440.18, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 954.85, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALL POLY PAT VE 38 MM DIA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771038272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 954.85, "maximum": 2440.18, "gross_charge": 2652.38, "discounted_cash": 3315.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 981.38, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2440.18, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 954.85, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1989.28, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALL PURPOSE DRAINAGE CATHETER APD", "code_information": [{"code": "771020468", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 904.19, "discounted_cash": 1130.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALL PURPOSE PADDED MESH W/C GLOVE", "code_information": [{"code": "771020979", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 84.98, "discounted_cash": 106.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEN ARM TRAP", "code_information": [{"code": "771011386", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 357.43, "discounted_cash": 446.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITH MCC", "code_information": [{"code": "915", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9350.34, "maximum": 21033.02, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 9350.34, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17457.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 21033.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 21033.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18929.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 20884.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 11194.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 9350.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 10341.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 11194.39, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 13859.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [{"code": "916", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2079.38, "maximum": 7803.2, "estimated_discounted_cash": 13171.2, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 2079.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6476.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 7803.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 7803.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7022.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 7755.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4277.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2079.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3951.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4277.69, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5296.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLERGY PATCH TESTS", "code_information": [{"code": "95044", "type": "CPT"}], "standard_charges": [{"minimum": 49.57, "maximum": 1743.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1743.32, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1016.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 938.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1016.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLERGY/IMMUNOLOGY SS", "code_information": [{"code": "G0060", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLEVYN 4X4IN DRESSING TAKE HOME", "code_information": [{"code": "A6212", "type": "HCPCS"}, {"code": "771030733", "type": "CDM"}, {"code": "623", "type": "RC"}], "standard_charges": [{"minimum": 13.16, "maximum": 40.05, "gross_charge": 43.54, "discounted_cash": 54.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 28.73, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 28.73, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 28.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 32.65, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 32.65, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 19.88, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 40.05, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 15.67, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 32.65, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLEVYN ADHESIVE 5X5", "code_information": [{"code": "771013367", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 54.78, "discounted_cash": 68.48, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEVYN ADHESIVE 5X5 TAKE HOME", "code_information": [{"code": "A6213", "type": "HCPCS"}, {"code": "771030734", "type": "CDM"}, {"code": "623", "type": "RC"}], "standard_charges": [{"minimum": 18.24, "maximum": 46.63, "gross_charge": 50.69, "discounted_cash": 63.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 33.45, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 33.45, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 33.45, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 38.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 38.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 30.41, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 46.63, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 18.24, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 38.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLEVYN ADHESIVE 7X7", "code_information": [{"code": "771015276", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 99.74, "discounted_cash": 124.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEVYN DRESSING 8X8IN", "code_information": [{"code": "771008282", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 155.94, "discounted_cash": 194.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEVYN DRESSING 8X8IN TAKE HOME", "code_information": [{"code": "A6211", "type": "HCPCS"}, {"code": "771030736", "type": "CDM"}, {"code": "623", "type": "RC"}], "standard_charges": [{"minimum": 39.81, "maximum": 134.28, "gross_charge": 145.96, "discounted_cash": 182.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 96.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 96.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 96.33, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 109.47, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 109.47, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 60.12, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 134.28, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 43.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 39.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 43.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 52.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 109.47, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLEVYN GENTLE BOARDER 3X3", "code_information": [{"code": "771030358", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 35.81, "discounted_cash": 44.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEVYN GENTLE BORDER SACRUM", "code_information": [{"code": "771040642", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 82.87, "discounted_cash": 103.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEVYN GENTLE SOFT ADHESIVE", "code_information": [{"code": "771030359", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 47.76, "discounted_cash": 59.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEVYN HEEL", "code_information": [{"code": "771021495", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 116.6, "discounted_cash": 145.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEVYN HEEL TAKE HOME", "code_information": [{"code": "A6210", "type": "HCPCS"}, {"code": "771030735", "type": "CDM"}, {"code": "623", "type": "RC"}], "standard_charges": [{"minimum": 27.0, "maximum": 100.02, "gross_charge": 108.72, "discounted_cash": 135.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 71.75, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 71.75, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 71.75, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 81.54, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 81.54, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 40.79, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 100.02, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 39.13, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 81.54, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLEVYN SACRAL LIFE", "code_information": [{"code": "771042156", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 688.5, "discounted_cash": 860.63, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEVYN SACRUM 17CM X 17CM", "code_information": [{"code": "771022207", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 89.34, "discounted_cash": 111.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}], "standard_charges": [{"minimum": 7.73, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}], "standard_charges": [{"minimum": 17.39, "maximum": 28.94, "estimated_discounted_cash": 470.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 18.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 18.83, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}], "standard_charges": [{"minimum": 11872.0, "maximum": 21628.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 15613.66, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 21628.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 21628.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 16935.06, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21317.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11872.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLIGATOR FORCEP 5.5 20/CASE", "code_information": [{"code": "771027125", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 154.95, "discounted_cash": 193.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLIGATOR FORCEP,DISPOSABLE", "code_information": [{"code": "771024161", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 140.05, "discounted_cash": 175.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLOCGRAFT ANTERIOR TIBIALIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771026974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2746.95, "maximum": 7020.0, "gross_charge": 7630.44, "discounted_cash": 9538.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2823.26, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2823.26, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2823.26, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 5722.83, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 5722.83, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7020.0, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2746.95, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 5722.83, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOCRAFT CL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "771031421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4278.97, "maximum": 10935.14, "gross_charge": 11886.03, "discounted_cash": 14857.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4397.83, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4397.83, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4397.83, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 8914.52, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8914.52, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 10935.14, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4278.97, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 8914.52, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOCSYNC PURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771037238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1566.24, "maximum": 4002.61, "gross_charge": 4350.67, "discounted_cash": 5438.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1609.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1609.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1609.74, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3263.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3263.0, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4002.61, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1566.24, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3263.0, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODER TISSUE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "771026567", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 66.25, "maximum": 169.31, "gross_charge": 184.04, "discounted_cash": 230.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 68.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 68.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 68.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 138.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 138.03, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 169.31, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 66.25, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 138.03, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODER TISSUE 5X12", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "771026566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3337.58, "maximum": 8529.38, "gross_charge": 9271.07, "discounted_cash": 11588.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3430.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3430.29, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3430.29, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6953.3, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6953.3, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 8529.38, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3337.58, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6953.3, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODERM 8X16", "code_information": [{"code": "771026802", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 20825.51, "discounted_cash": 26031.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLODERM 8X16", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "771029236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 66.25, "maximum": 169.31, "gross_charge": 184.04, "discounted_cash": 230.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 68.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 68.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 68.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 138.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 138.03, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 169.31, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 66.25, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 138.03, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODERM CONT. PER SQ CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "771035053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 28.31, "maximum": 72.36, "gross_charge": 78.66, "discounted_cash": 98.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 29.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 29.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 29.1, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 58.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 58.99, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 72.36, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 28.31, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 58.99, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODERM CONTOUR (PER SQ CM)", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "771034798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 41.97, "maximum": 107.27, "gross_charge": 116.6, "discounted_cash": 145.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 43.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 43.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 43.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 87.45, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 87.45, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 107.27, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 41.97, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 87.45, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODERM CONTOUR LARGE 328 SQ CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "771033894", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 31.35, "maximum": 80.13, "gross_charge": 87.1, "discounted_cash": 108.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 40.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 40.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 40.93, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 65.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 65.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 35.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 80.13, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 31.35, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 65.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODERM MESH 16X20", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "771026904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19039.14, "maximum": 48655.58, "gross_charge": 52886.51, "discounted_cash": 66108.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 19568.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 19568.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 19568.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 39664.88, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 39664.88, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 48655.58, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 19039.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 39664.88, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODERM MESH 6X16 982196", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "771029212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 66.25, "maximum": 169.31, "gross_charge": 184.04, "discounted_cash": 230.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 68.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 68.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 68.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 138.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 138.03, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 169.31, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 66.25, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 138.03, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODERM TISSUE 6X12", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "771026799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4017.44, "maximum": 10266.79, "gross_charge": 11159.56, "discounted_cash": 13949.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4129.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4129.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4129.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 8369.67, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8369.67, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 10266.79, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4017.44, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 8369.67, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOGEN, PER CC", "code_information": [{"code": "Q4212", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [{"code": "14", "type": "MS-DRG"}], "standard_charges": [{"minimum": 77963.07, "maximum": 151270.54, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 86510.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 125556.52, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 151270.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 151270.54, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 136144.65, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 134918.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 84393.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 86510.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 77963.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 84393.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 104486.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOGENIC GRAFT (1ST 25 SQCM) T/A/L", "code_information": [{"code": "15271", "type": "CPT"}, {"code": "656030296", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 881.16, "maximum": 6930.42, "gross_charge": 2999.93, "discounted_cash": 3749.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 881.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1979.95, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1979.95, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1979.95, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5003.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6930.42, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6930.42, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5426.45, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2249.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2249.94, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2953.8, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2759.93, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1827.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 881.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1687.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1827.0, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1079.97, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2249.94, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOGENIC GRAFT (ADDT'L 25 SQCM) T/A/L", "code_information": [{"code": "15272", "type": "CPT"}, {"code": 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"Cigna", "plan_name": "POS", "standard_charge_dollar": 13780.15, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 13780.15, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 16903.65, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 6614.47, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 13780.15, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOGRAFT SPACER 11MM", "code_information": [{"code": "771020645", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17207.56, "discounted_cash": 21509.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLOGRAFT SPACER 13MM", "code_information": [{"code": "771020644", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18974.94, "discounted_cash": 23718.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLOGRAFT STRATTIS 20X25", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "771031090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 37637.19, "maximum": 96183.94, "gross_charge": 104547.77, "discounted_cash": 130684.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 38682.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 38682.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 38682.67, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 78410.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 78410.82, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 96183.94, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 37637.19, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 78410.82, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON POSTEIN TIBIALS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "771030007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.16, "maximum": 7442.2, "gross_charge": 8089.35, "discounted_cash": 10111.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2993.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2993.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2993.05, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6067.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6067.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7442.2, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2912.16, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6067.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOPATCH 4X8 472408", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "771029246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3524.24, "maximum": 9006.4, "gross_charge": 9789.57, "discounted_cash": 12236.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3622.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3622.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3622.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7342.17, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7342.17, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9006.4, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3524.24, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7342.17, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4115", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.52, "maximum": 14.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4123", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.36, "maximum": 37.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 37.36, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN AC, 1 CM", "code_information": [{"code": "Q4141", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.14, "maximum": 47.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC DBM PUTTY 2.5", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "771037674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 689.14, "maximum": 1761.13, "gross_charge": 1914.28, "discounted_cash": 2392.85, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1435.71, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1435.71, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1761.13, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 689.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1435.71, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC PURE 2.5CC", "code_information": [{"code": "771037456", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3271.53, "discounted_cash": 4089.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLOSYNC PURE 5.0 CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "771037876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3693.98, "maximum": 9440.17, "gross_charge": 10261.06, "discounted_cash": 12826.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3796.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3796.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3796.59, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7695.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7695.79, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9440.17, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3693.98, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7695.79, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOWRAP DS OR DRY 1 SQ CM", "code_information": [{"code": "Q4150", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.23, "maximum": 89.23, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 89.23, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOWRAP DS WET 2X4CM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5489.44, "maximum": 14028.59, "gross_charge": 15248.47, "discounted_cash": 19060.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5641.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5641.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5641.93, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 11436.35, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 11436.35, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 14028.59, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5489.44, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 11436.35, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOWRAP DS WET 4X4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771034091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8084.97, "maximum": 20661.6, "gross_charge": 22458.27, "discounted_cash": 28072.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8309.55, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8309.55, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8309.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 16843.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 16843.7, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 20661.6, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 8084.97, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 16843.7, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLURE QUADRA RF", "code_information": [{"code": "C2621", "type": "HCPCS"}, {"code": "771042725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 15098.07, "maximum": 38583.97, "gross_charge": 41939.1, "discounted_cash": 52423.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 15517.46, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 15517.46, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 15517.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 31454.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 31454.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 38583.97, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 15098.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 31454.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.69, "maximum": 6.51, "estimated_discounted_cash": 4487.96, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 4487.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 4487.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}], "standard_charges": [{"minimum": 14.03, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}], "standard_charges": [{"minimum": 16.49, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}], "standard_charges": [{"minimum": 62.48, "maximum": 100.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 80.51, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 67.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 62.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 67.63, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHAVENT KNOTLESS SP 5.5MM PEEK ANCHOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1674.83, "maximum": 4280.13, "gross_charge": 4652.32, "discounted_cash": 5815.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1721.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1721.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1721.35, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3489.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3489.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4280.13, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1674.83, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3489.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHAVENT KNOTLSS 6.5MM PEEK ANCHR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771049821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1687.24, "maximum": 4311.83, "gross_charge": 4686.78, "discounted_cash": 5858.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1734.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1734.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1734.1, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3515.08, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3515.08, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4311.83, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1687.24, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3515.08, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHAVENT KNTLSS SP PEEK ANCHR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1674.83, "maximum": 4280.13, "gross_charge": 4652.32, "discounted_cash": 5815.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1721.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1721.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1721.35, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3489.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3489.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4280.13, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1674.83, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3489.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL FOR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.51, "maximum": 10.78, "estimated_discounted_cash": 853.0, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL FOR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0270", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 853.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL FOR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0270", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 853.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL URETHRAL SUPPOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0275", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 29.12, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL URETHRAL SUPPOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0275", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL URETHRAL SUPPOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0275", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ASSIST - LAWTON", "code_information": [{"code": "A0424", "type": "HCPCS"}, {"code": "673070270", "type": "CDM"}, {"code": "540", "type": "RC"}], "standard_charges": [{"minimum": 112.79, "maximum": 288.25, "gross_charge": 313.32, "discounted_cash": 391.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 206.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 206.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 206.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 234.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 234.99, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 187.99, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 288.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 112.79, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 234.99, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ASSIST - WALTERS", "code_information": [{"code": "A0424", "type": "HCPCS"}, {"code": "674570270", "type": "CDM"}, {"code": "540", "type": "RC"}], "standard_charges": [{"minimum": 112.79, "maximum": 288.25, "gross_charge": 313.32, "discounted_cash": 391.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 206.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 206.79, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 206.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 234.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 234.99, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 187.99, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 288.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 112.79, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 234.99, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS DEFIBRILLATION SUPPLIES", "code_information": [{"code": "A0392", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS EMERGENCY", "code_information": [{"code": "A0427", "type": "HCPCS"}, {"code": "673070261", "type": "CDM"}, {"code": "540", "type": "RC"}], "standard_charges": [{"minimum": 647.98, "maximum": 1655.95, "gross_charge": 1799.95, "discounted_cash": 2249.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1187.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1187.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1187.96, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1349.96, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1349.96, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1575.94, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1655.95, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 647.98, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1349.96, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ESOPHAGEAL INTUB SUPPLS", "code_information": [{"code": "A0396", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS IV DRUG THERAPY SUPPLIES", "code_information": [{"code": "A0394", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS LEVEL 2 - LAWTON", "code_information": [{"code": "A0433", "type": "HCPCS"}, {"code": "673075794", "type": "CDM"}, {"code": "540", "type": "RC"}], "standard_charges": [{"minimum": 721.83, "maximum": 1960.23, "gross_charge": 2005.11, "discounted_cash": 2506.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1323.37, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1323.37, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1323.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1503.83, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1503.83, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1960.23, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1844.7, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 721.83, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1503.83, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS LEVEL 2 - WALTERS", "code_information": [{"code": "A0433", "type": "HCPCS"}, {"code": "674575794", "type": "CDM"}, {"code": "540", "type": "RC"}], "standard_charges": [{"minimum": 721.83, "maximum": 1960.23, "gross_charge": 2005.11, "discounted_cash": 2506.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1323.37, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1323.37, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1323.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1503.83, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1503.83, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1960.23, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1844.7, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 721.83, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1503.83, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS NON-EMERGENCY", "code_information": [{"code": "A0426", "type": "HCPCS"}, {"code": "673070260", "type": "CDM"}, {"code": "540", "type": "RC"}], "standard_charges": [{"minimum": 388.48, "maximum": 992.79, "gross_charge": 1079.12, "discounted_cash": 1348.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 712.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 712.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 712.21, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 809.34, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 809.34, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 855.36, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 992.79, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 388.48, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 809.34, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS NON-EMERGENCY - WALTERS", "code_information": [{"code": "A0426", "type": "HCPCS"}, {"code": "674570260", "type": "CDM"}, {"code": "540", "type": "RC"}], "standard_charges": [{"minimum": 388.48, "maximum": 992.79, "gross_charge": 1079.12, "discounted_cash": 1348.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 712.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 712.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 712.21, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 809.34, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 809.34, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 855.36, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 992.79, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 388.48, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 809.34, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ROUTINE DISPOSBLE SUPPLS", "code_information": [{"code": "A0398", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALT (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "701101665", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.14, "maximum": 87.9, "gross_charge": 95.55, "discounted_cash": 119.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 63.06, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 63.06, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 63.06, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 71.66, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 71.66, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 87.9, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 34.39, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 71.66, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALT LONG-TERM CNTRL MED RXD", "code_information": [{"code": "4144F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALTEPLASE RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 1320.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALTRUA 60 DDDR IS-1", "code_information": [{"code": "C1785", "type": "HCPCS"}, {"code": "771030937", "type": "CDM"}, {"code": "275", "type": "RC"}], "standard_charges": [{"minimum": 11667.9, "maximum": 29817.98, "gross_charge": 32410.85, "discounted_cash": 40513.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 11992.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 11992.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 11992.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 24308.13, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 24308.13, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 29817.98, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 11667.9, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 24308.13, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.28, "maximum": 6.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5.28, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4.63, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALUE BYPASS TOOL", "code_information": [{"code": "771039777", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 189.66, "discounted_cash": 237.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALUMAFOAM NASAL SPLINT", "code_information": [{"code": "771006235", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.86, "discounted_cash": 41.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALUMI-HAND LARGE 760", "code_information": [{"code": "771016726", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 248.69, "discounted_cash": 310.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALUMINUM CRUTCHES,ADULT LARGE", "code_information": [{"code": "771012671", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 10.52, "discounted_cash": 13.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY NOT W/EXTRACTS", "code_information": [{"code": "D7321", "type": "HCPCS"}], "standard_charges": [{"minimum": 348.0, "maximum": 6865.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4956.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5375.59, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1366.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY W/EXTRACT 1-3", "code_information": [{"code": "D7311", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.0, "maximum": 6865.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4956.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5375.59, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1366.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOLUS CLSD REDUC STBLZ TE", "code_information": [{"code": "D7771", "type": "HCPCS"}], "standard_charges": [{"minimum": 2992.32, "maximum": 6865.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4956.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5375.59, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3239.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2992.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3239.11, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOLUS OPEN REDUCTION", "code_information": [{"code": "D7671", "type": "HCPCS"}], "standard_charges": [{"minimum": 4956.15, "maximum": 6865.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4956.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5375.59, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5908.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5458.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5908.44, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOPLASTY W/ EXTRACTION", "code_information": [{"code": "D7310", "type": "HCPCS"}], "standard_charges": [{"minimum": 264.0, "maximum": 6865.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4956.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5375.59, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1366.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOPLASTY W/O EXTRACTION", "code_information": [{"code": "D7320", "type": "HCPCS"}], "standard_charges": [{"minimum": 379.0, "maximum": 6865.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4956.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5375.59, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 379.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1366.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG 15 MIN", "code_information": [{"code": "95983", "type": "CPT"}], "standard_charges": [{"minimum": 84.69, "maximum": 161.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 161.4, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG ADDL 15", "code_information": [{"code": "95984", "type": "CPT"}], "standard_charges": [{"minimum": 61.47, "maximum": 61.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS CPLX CN NPGT PRGRMG", "code_information": [{"code": "95977", "type": "CPT"}], "standard_charges": [{"minimum": 84.69, "maximum": 161.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 161.4, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS CPLX SP/PN NPGT W/PRGRM", "code_information": [{"code": "95972", "type": "CPT"}], "standard_charges": [{"minimum": 84.69, "maximum": 161.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 161.4, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS NPGT W/O PRGRMG", "code_information": [{"code": "95970", "type": "CPT"}], "standard_charges": [{"minimum": 90.65, "maximum": 212.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 90.65, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 212.99, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS SMPL SP/PN NPGT W/PRGRM", "code_information": [{"code": "95971", "type": "CPT"}], "standard_charges": [{"minimum": 84.69, "maximum": 161.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 161.4, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AM RESP/SLEEP STUDY PNEUMOCARDIOG", "code_information": [{"code": "94772", "type": "CPT"}, {"code": "621112500", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 116.31, "maximum": 1880.11, "gross_charge": 2043.6, "discounted_cash": 2554.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1348.77, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1348.77, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1348.77, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 116.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 161.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 161.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 126.16, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1532.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1532.7, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 893.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1880.11, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 529.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 489.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 529.96, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 735.69, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1532.7, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMALGAM 4 OR > SURFACES PERM", "code_information": [{"code": "D2161", "type": "HCPCS"}], "standard_charges": [{"minimum": 228.0, "maximum": 4687.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3383.73, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 4687.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 4687.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3670.1, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 228.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMALGAM ONE SURFACE PERMANEN", "code_information": [{"code": "D2140", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.0, "maximum": 4388.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3167.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 4388.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 4388.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3435.85, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMALGAM THREE SURFACES PERMA", "code_information": [{"code": "D2160", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.0, "maximum": 4687.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3383.73, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 4687.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 4687.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3670.1, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 191.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMALGAM TWO SURFACES PERMANE", "code_information": [{"code": "D2150", "type": "HCPCS"}], "standard_charges": [{"minimum": 159.0, "maximum": 4388.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3167.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 4388.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 4388.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3435.85, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SOFTWARE", "code_information": [{"code": "93784", "type": "CPT"}], "standard_charges": [{"minimum": 69.89, "maximum": 339.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW I&R", "code_information": [{"code": "93790", "type": "CPT"}], "standard_charges": [{"minimum": 27.81, "maximum": 27.81, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULANCE 02 LIFE SUSTAINING", "code_information": [{"code": "A0422", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULANCE WAITING 1/2 HR", "code_information": [{"code": "A0420", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SETTING SUBSTANCE", "code_information": [{"code": "S9475", "type": "HCPCS"}], "standard_charges": [{"minimum": 579.8, "maximum": 803.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 579.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 803.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 628.87, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SURGICAL BOOT EAC", "code_information": [{"code": "L3260", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 405.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SURGICAL BOOT EAC", "code_information": [{"code": "L3260", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 405.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SURGICAL BOOT EAC", "code_information": [{"code": "L3260", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 405.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SURGICAL BOOT EAC", "code_information": [{"code": "L3260", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 405.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY TRACTION DEVICE", "code_information": [{"code": "E0830", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMC SMALL STAT 1554-01-180", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771025583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7925.13, "maximum": 20253.11, "gross_charge": 22014.26, "discounted_cash": 27517.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8145.27, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8145.27, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8145.27, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 16510.69, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 16510.69, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 20253.11, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7925.13, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 16510.69, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMD PACKING 1/2IN TAKE HOME", "code_information": [{"code": "A6407", "type": "HCPCS"}, {"code": "771030738", "type": "CDM"}, {"code": "623", "type": "RC"}], "standard_charges": [{"minimum": 2.53, "maximum": 40.05, "gross_charge": 43.54, "discounted_cash": 54.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 28.73, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 28.73, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 28.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 32.65, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 32.65, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 40.05, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 2.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2.53, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 2.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 15.67, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 32.65, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMD PACKING 1/4IN TAKE HOME", "code_information": [{"code": "A6407", "type": "HCPCS"}, {"code": "771030737", "type": "CDM"}, {"code": "623", "type": "RC"}], "standard_charges": [{"minimum": 2.53, "maximum": 15.09, "gross_charge": 16.41, "discounted_cash": 20.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 10.83, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 10.83, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 10.83, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 12.3, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 12.3, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 15.09, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 2.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2.53, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 2.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5.9, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 12.3, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMEFA FORK", "code_information": [{"code": "771013790", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 103.96, "discounted_cash": 129.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMI RECTO ANAL REPAIR PROBE", "code_information": [{"code": "771030062", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2821.06, "discounted_cash": 3526.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMIFOSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0207", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMIKACIN SULFATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0278", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.98, "maximum": 1.4, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.98, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMIKACIN SULFATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0278", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMIKACIN SULFATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0278", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINES VAGINAL FLUID QUAL", "code_information": [{"code": "82120", "type": "CPT"}], "standard_charges": [{"minimum": 5.81, "maximum": 307.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 307.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 307.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 307.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 307.34, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 7.49, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACID SINGLE QUAL", "code_information": [{"code": "82127", "type": "CPT"}], "standard_charges": [{"minimum": 13.75, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 17.73, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS MULT QUAL", "code_information": [{"code": "82128", "type": "CPT"}], "standard_charges": [{"minimum": 13.45, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 14.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 14.56, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUAN 6 OR MORE", "code_information": [{"code": "82139", "type": "CPT"}], "standard_charges": [{"minimum": 16.36, "maximum": 33.14, "estimated_discounted_cash": 42.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUANT 2-5", "code_information": [{"code": "82136", "type": "CPT"}], "standard_charges": [{"minimum": 19.02, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 19.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS SINGLE QUANT", "code_information": [{"code": "82131", "type": "CPT"}], "standard_charges": [{"minimum": 22.29, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 28.73, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINOLEVULINIC ACID HCL TOP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7308", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.51, "maximum": 452.05, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 452.05, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 394.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 364.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 394.78, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINOLEVULINIC ACID HCL TOP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7308", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINOLEVULINIC ACID HCL TOP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7308", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINOLEVULINIC ACID, 10% GEL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7345", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.59, "maximum": 14.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1.94, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1.72, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINOPHYLLIN 250 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0280", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.08, "maximum": 14.88, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 10.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINOPHYLLIN 250 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0280", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINOPHYLLIN 250 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0280", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMIODARONE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0282", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.26, "maximum": 0.62, "estimated_discounted_cash": 314.47, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMIODARONE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0282", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 314.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMIODARONE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0282", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 314.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMITRIPTYLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1320", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.62, "maximum": 0.62, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMITRIPTYLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1320", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMITRIPTYLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1320", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMK CRUCIATE 1488-07-000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771025502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 634.32, "maximum": 1621.05, "gross_charge": 1762.02, "discounted_cash": 2202.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 651.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 651.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 651.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1321.51, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1321.51, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1621.05, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 634.32, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1321.51, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMK CRUCIATE RET. FEM 1488-06-000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771025417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9192.78, "maximum": 23492.67, "gross_charge": 25535.52, "discounted_cash": 31919.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 9448.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 9448.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 9448.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 19151.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 19151.64, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 23492.67, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9192.78, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 19151.64, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMK FEM COMPONENT LEFT SZ 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771015342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9192.78, "maximum": 23492.67, "gross_charge": 25535.52, "discounted_cash": 31919.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 9448.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 9448.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 9448.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 19151.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 19151.64, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 23492.67, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9192.78, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 19151.64, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMK FEMORAL COMP 1488-08", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771015228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9192.78, "maximum": 23492.67, "gross_charge": 25535.52, "discounted_cash": 31919.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 9448.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 9448.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 9448.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 19151.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 19151.64, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 23492.67, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9192.78, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 19151.64, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMK FEMORAL COMP SZ2 LEFT 1488-04", "code_information": [{"code": "771017304", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"gross_charge": 13799.66, "discounted_cash": 17249.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMK FEMORAL COMPONENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771013961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8675.3, "maximum": 22170.23, "gross_charge": 24098.08, "discounted_cash": 30122.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8916.28, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8916.28, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8916.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 18073.56, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 18073.56, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 22170.23, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 8675.3, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 18073.56, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMK FEMORAL COMPONENT 1488-05", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771016556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7898.82, "maximum": 20185.88, "gross_charge": 21941.18, "discounted_cash": 27426.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8118.23, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8118.23, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8118.23, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 16455.88, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 16455.88, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 20185.88, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7898.82, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 16455.88, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMK FIXED STEM 1888-33", "code_information": [{"code": "771015284", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"gross_charge": 8345.35, "discounted_cash": 10431.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMK FIXED STEM 1888-35 CONSIGNMEN", "code_information": [{"code": "771015227", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"gross_charge": 8846.71, "discounted_cash": 11058.39, "setting": "outpatient", "billing_class": 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"billing_class": "facility"}]}, {"description": "AMMONIA TEST STRIPS", "code_information": [{"code": "A4774", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding 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"methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNICORE PRO, PER SQ CM", "code_information": [{"code": "Q4298", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data 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"fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 739.66, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 289.43, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 602.98, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO BAND MEMBRANE 2 X 2", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "771048427", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 151.48, "maximum": 3975.78, "gross_charge": 4321.51, "discounted_cash": 5401.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2031.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 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"facility"}]}, {"description": "AMNIO BAND MEMBRANE 2 X 3", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "771048428", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 151.48, "maximum": 4160.71, "gross_charge": 4522.52, "discounted_cash": 5653.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2125.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2125.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2125.58, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3391.89, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3391.89, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 151.48, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4160.71, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1628.1, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3391.89, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO BAND MEMBRANE 2 X 4", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "771048429", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 151.48, "maximum": 4438.09, "gross_charge": 4824.02, "discounted_cash": 6030.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2267.28, "methodology": "percent 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"standard_charge_dollar": 3618.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO BAND MEMBRANE 3X4", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "771048416", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 151.48, "maximum": 4992.86, "gross_charge": 5427.03, "discounted_cash": 6783.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2550.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2550.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2550.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4070.27, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4070.27, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 151.48, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4992.86, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1953.73, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4070.27, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO BAND VIABLE 2 X 2", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "771048432", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 151.48, "maximum": 3975.78, "gross_charge": 4321.51, "discounted_cash": 5401.89, "setting": "outpatient", 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1555.74, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3241.13, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO BAND VIABLE 5X5", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "771048433", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 151.48, "maximum": 12758.94, "gross_charge": 13868.42, "discounted_cash": 17335.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 6518.15, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 6518.15, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 6518.15, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 10401.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 10401.31, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 151.48, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 12758.94, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4992.63, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 10401.31, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO MEMBRANE 14 MM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "771048424", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 151.48, "maximum": 1294.09, "gross_charge": 1406.63, "discounted_cash": 1758.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 661.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 661.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 661.11, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1054.97, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1054.97, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 151.48, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1294.09, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 506.38, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1054.97, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO MEMBRANE 4 X 4", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "771048430", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 151.48, "maximum": 12204.83, "gross_charge": 13266.13, "discounted_cash": 16582.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 6235.08, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 6235.08, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 6235.08, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9949.59, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9949.59, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 151.48, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 12204.83, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4775.8, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9949.59, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO OR BIODMATRIX, INJ 1CC", "code_information": [{"code": "Q4139", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO OR DERMA TL, PER SQ CM", "code_information": [{"code": "Q4225", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO QUAD-CORE, PER SQ CM", "code_information": [{"code": "Q4294", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO TRI-CORE, PER SQ CM", "code_information": [{"code": "Q4295", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO WOUND, PER SQUARE CM", "code_information": [{"code": "Q4181", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO-MAXX OR LITE PER SQ CM", "code_information": [{"code": "Q4239", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOAMP-MP PER SQ CM", "code_information": [{"code": "Q4250", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOARMOR 1 SQ CM", "code_information": [{"code": "Q4188", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND, 1 MG", "code_information": [{"code": "Q4168", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS TESTING", "code_information": [{"code": "59000", "type": "CPT"}, {"code": "620512250", "type": "CDM"}, {"code": "720", "type": "RC"}], "standard_charges": [{"minimum": 54.03, "maximum": 1302.13, "gross_charge": 384.28, "discounted_cash": 480.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 54.03, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 253.62, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 253.62, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 253.62, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 307.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 426.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 426.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 333.82, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 288.21, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 288.21, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1302.13, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 353.53, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 869.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 54.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 803.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 869.68, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 138.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 288.21, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS THERAPEUTIC", "code_information": [{"code": "59001", "type": "CPT"}], "standard_charges": [{"minimum": 280.67, "maximum": 2556.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1845.29, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 2556.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 2556.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2001.46, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 519.62, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 303.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 280.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 303.82, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS TRAY 20GA X 3 1/2\"", "code_information": [{"code": "771009246", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 136.27, "discounted_cash": 170.34, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMNIOCLEAR MEMBRANE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771033903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3310.26, "maximum": 8459.57, "gross_charge": 9195.19, "discounted_cash": 11493.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3402.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3402.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3402.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6896.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6896.39, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 8459.57, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3310.26, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6896.39, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOCORE PER SQ CM", "code_information": [{"code": "Q4227", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOCYTE PLUS, PER 0.5 CC", "code_information": [{"code": "Q4242", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOEXCEL BIODEXCEL 1SQ CM", "code_information": [{"code": "Q4137", "type": "HCPCS"}], "standard_charges": [{"minimum": 119.6, "maximum": 119.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 119.6, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNION BIO OR AXOBIO SQ CM", "code_information": [{"code": "Q4211", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNION THICK 3 X 6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5274.42, "maximum": 13479.07, "gross_charge": 14651.17, "discounted_cash": 18313.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5420.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5420.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5420.93, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 10988.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 10988.37, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 13479.07, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5274.42, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 10988.37, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNION THICK 3X4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771049799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3765.52, "maximum": 9623.0, "gross_charge": 10459.79, "discounted_cash": 13074.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3870.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3870.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3870.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7844.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7844.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9623.0, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3765.52, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7844.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOREPAIR OR ALTIPLY SQ CM", "code_information": [{"code": "Q4235", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTEXT PATCH, PER SQ CM", "code_information": [{"code": "Q4247", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTEXT, PER CC", "code_information": [{"code": "Q4245", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC FLUID SCAN", "code_information": [{"code": "82143", "type": "CPT"}], "standard_charges": [{"minimum": 9.07, "maximum": 33.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 9.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 9.82, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC MEMBRANCE GRAFT", "code_information": [{"code": "V2790", "type": "HCPCS"}, {"code": "771026831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1238.31, "maximum": 3164.57, "gross_charge": 3439.75, "discounted_cash": 4299.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2270.23, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2270.23, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2270.23, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2579.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2579.81, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2063.85, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3164.57, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1238.31, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2579.81, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC MEMBRANCE GRAFT 1.5X1", "code_information": [{"code": "V2790", "type": "HCPCS"}, {"code": "771034412", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 1093.13, "maximum": 2793.56, "gross_charge": 3036.48, "discounted_cash": 3795.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2004.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2004.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2004.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2277.36, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2277.36, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1821.88, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2793.56, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1093.13, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2277.36, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOWRAP2 PER SQ CM", "code_information": [{"code": "Q4221", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIPLY, PER SQ CM", "code_information": [{"code": "Q4249", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNISURE", "code_information": [{"code": "84112", "type": "CPT"}, {"code": "701807497", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 95.17, "maximum": 266.32, "gross_charge": 289.48, "discounted_cash": 361.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 191.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 191.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 191.05, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 217.11, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 217.11, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 266.32, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 95.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 104.21, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 217.11, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNISURE ROM TEST", "code_information": [{"code": "771030670", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 515.38, "discounted_cash": 644.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMNT PAIN NOTED NONE PRSNT", "code_information": [{"code": "1126F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNT PAIN NOTED PAIN PRSNT", "code_information": [{"code": "1125F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOBARBITAL 125 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0300", "type": "HCPCS"}], "standard_charges": [{"minimum": 130.23, "maximum": 139.51, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 130.23, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOBARBITAL 125 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0300", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOBARBITAL 125 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0300", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOX W/WO CLAV RX", "code_information": [{"code": "G9315", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOXIC NOT PRESC AS 1ST LINE", "code_information": [{"code": "G9313", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 3OR 4", "code_information": [{"code": "80325", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 5 OR MORE", "code_information": [{"code": "80326", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical 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{"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1024.71, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1024.71, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2077.13, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2077.13, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2547.94, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 997.02, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2077.13, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHIRION DEEP 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{"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1416.36, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1737.4, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 679.85, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1416.36, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHIRION DEEP 3x40x150", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771041649", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 683.39, "maximum": 1746.45, "gross_charge": 1898.32, "discounted_cash": 2372.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 702.37, "methodology": 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{"description": "AMPHIRION DEEP 4.0X120X150", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771042714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 679.85, "maximum": 1737.4, "gross_charge": 1888.48, "discounted_cash": 2360.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 698.73, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 698.73, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 698.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1416.36, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1416.36, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1737.4, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 679.85, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1416.36, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHIRION DEEP 4.0X40X150", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771042332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 670.74, "maximum": 1714.12, "gross_charge": 1863.18, "discounted_cash": 2328.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 689.37, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 689.37, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 689.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1397.38, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1397.38, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1714.12, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 670.74, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1397.38, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHIRION DEEP 4X80X150", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771041648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 683.39, "maximum": 1746.45, "gross_charge": 1898.32, "discounted_cash": 2372.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 702.37, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 702.37, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 702.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1423.74, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1423.74, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1746.45, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 683.39, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1423.74, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHO B CHOLESTERYL SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0288", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.88, "maximum": 14.88, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHO B CHOLESTERYL SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0288", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHO B CHOLESTERYL SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0288", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0285", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.69, "maximum": 43.97, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 43.97, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0285", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0285", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPID COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0287", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.51, "maximum": 14.88, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPID COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0287", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPID COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0287", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPOSOME INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.88, "maximum": 31.56, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 23.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 23.95, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPOSOME INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0289", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPOSOME INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0289", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 500 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0290", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.14, "maximum": 1.4, "estimated_discounted_cash": 630.03, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_percentage": 75.0, "possible_amount": 503.54, "count": "1 through 10", "median_amount": 366.67, "methodology": "percent of total billed charges", "10th_percentile": 366.67, "90th_percentile": 640.4}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 503.54, "count": "1 through 10", "median_amount": 366.67, "methodology": "percent of total billed charges", "10th_percentile": 366.67, "90th_percentile": 640.4}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1.14, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 500 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0290", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 630.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 47.0, "possible_amount": 868.96, "count": "1 through 10", "median_amount": 868.96, "methodology": "percent of total billed charges", "10th_percentile": 868.96, "90th_percentile": 868.96}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 47.0, "possible_amount": 868.96, "count": "1 through 10", "median_amount": 868.96, "methodology": "percent of total billed charges", "10th_percentile": 868.96, "90th_percentile": 868.96}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 500 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0290", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 630.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 47.0, "possible_amount": 868.96, "count": "1 through 10", "median_amount": 868.96, "methodology": "percent of total billed charges", "10th_percentile": 868.96, "90th_percentile": 868.96}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 47.0, "possible_amount": 868.96, "count": "1 through 10", "median_amount": 868.96, "methodology": "percent of total billed charges", "10th_percentile": 868.96, "90th_percentile": 868.96}], "billing_class": "facility"}]}, {"description": "AMPICILLIN SULBACTAM 1.5 GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0295", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.42, "maximum": 3.26, "estimated_discounted_cash": 1397.58, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2.42, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 96.7, "count": "1 through 10", "median_amount": 96.7, "methodology": "percent of total billed charges", "10th_percentile": 96.7, "90th_percentile": 96.7}], "billing_class": "facility"}]}, {"description": "AMPICILLIN SULBACTAM 1.5 GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0295", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 1397.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN SULBACTAM 1.5 GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0295", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 1397.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPLATZ 035 260", "code_information": [{"code": "771042903", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 508.64, "discounted_cash": 635.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLATZ DRAINAGE CATHETER 12 FR", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "771027559", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 320.69, "maximum": 819.56, "gross_charge": 890.83, "discounted_cash": 1113.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 329.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 329.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 329.6, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 668.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 668.12, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 819.56, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 320.69, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 668.12, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPLATZ EXTRA STIFF WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771026526", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 67.26, "maximum": 171.9, "gross_charge": 186.85, "discounted_cash": 233.56, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 140.13, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 140.13, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 171.9, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 67.26, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 140.13, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPLATZ GOOSE NECK SNARE 20MM", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "771039869", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 730.43, "maximum": 1866.67, "gross_charge": 2028.99, "discounted_cash": 2536.24, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1521.74, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1521.74, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1866.67, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 730.43, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1521.74, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPLATZ GOOSENECK SNARE 30MM", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "771039858", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 730.43, "maximum": 1866.67, "gross_charge": 2028.99, "discounted_cash": 2536.24, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1521.74, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1521.74, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1866.67, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 730.43, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1521.74, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPLATZ SUPER STIFF WIRE 260CM", "code_information": [{"code": "771080012", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 615.42, "discounted_cash": 769.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLATZ URETERAL STENT 8.5F 24CM", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "771039841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.4, "maximum": 864.8, "gross_charge": 940.0, "discounted_cash": 1175.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 347.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 347.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 347.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 705.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 705.0, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 864.8, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 338.4, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 705.0, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPLATZ URETERAL STENT 8.5F 26CM", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "771039840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.4, "maximum": 864.8, "gross_charge": 940.0, "discounted_cash": 1175.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 347.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 347.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 347.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 705.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 705.0, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 864.8, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 338.4, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 705.0, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPLATZ WIRE 180", "code_information": [{"code": "771023253", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 570.46, "discounted_cash": 713.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLATZ\"GOOSE NECK\"SNARE", "code_information": [{"code": "771013402", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1978.4, "discounted_cash": 2473.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLATZ\"GOOSE NECK\"SNARE", "code_information": [{"code": "771013404", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1584.81, "discounted_cash": 1981.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLATZ\"GOOSE NEDK\"SNARE", "code_information": [{"code": "771013403", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1866.26, "discounted_cash": 2332.83, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLATZER 035 260", "code_information": [{"code": "771042904", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 590.14, "discounted_cash": 737.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLATZER PLUG II 12 MM", "code_information": [{"code": "771048829", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4796.62, "discounted_cash": 5995.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLATZER PLUG II 14 MM", "code_information": [{"code": "771048830", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4796.62, "discounted_cash": 5995.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLATZER PLUG II 16 MM", "code_information": [{"code": "771048831", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4796.62, "discounted_cash": 5995.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPLIA MRI QUAD", "code_information": [{"code": "C1882", "type": "HCPCS"}, {"code": "771043112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 40710.74, "maximum": 104038.56, "gross_charge": 113085.4, "discounted_cash": 141356.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 41841.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 41841.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 41841.59, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 84814.05, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 84814.05, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 104038.56, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 40710.74, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 84814.05, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25920", "type": "CPT"}], "standard_charges": [{"minimum": 6743.02, "maximum": 9340.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6743.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7313.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25922", "type": "CPT"}], "standard_charges": [{"minimum": 752.91, "maximum": 11205.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 752.91, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2603.26, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 752.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1476.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27590", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27591", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27592", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LOWER LEG AT KNEE", "code_information": [{"code": "27598", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE METACARPAL BONE", "code_information": [{"code": "26910", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 9340.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6743.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7313.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE UPPER ARM & IMPLANT", "code_information": [{"code": "24931", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24925", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 11205.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24930", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25907", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 11205.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25909", "type": "CPT"}], "standard_charges": [{"minimum": 6591.4, "maximum": 11587.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11587.76, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6591.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25924", "type": "CPT"}], "standard_charges": [{"minimum": 6743.02, "maximum": 9340.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6743.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7313.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25929", "type": "CPT"}], "standard_charges": [{"minimum": 881.16, "maximum": 6930.42, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 881.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5003.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6930.42, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6930.42, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5426.45, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2953.8, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1827.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 881.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1687.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1827.0, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25931", "type": "CPT"}], "standard_charges": [{"minimum": 2993.75, "maximum": 11205.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27594", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 11205.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27596", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27884", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 11205.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27886", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [{"code": "240", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11965.56, "maximum": 34672.37, "estimated_discounted_cash": 63607.86, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 11965.56, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28778.52, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34672.37, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34672.37, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 31205.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 33070.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 18758.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 11965.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 17329.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 18758.44, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 23224.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [{"code": "239", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20117.6, "maximum": 60397.45, "estimated_discounted_cash": 109559.74, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 20117.6, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 50130.67, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 60397.45, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 60397.45, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 54358.17, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 56586.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 32444.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 20117.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 29972.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 32444.34, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 40169.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC", "code_information": [{"code": "241", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7332.24, "maximum": 19207.68, "estimated_discounted_cash": 28665.48, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 7332.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 15942.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 19207.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 19207.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17287.06, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 16361.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 9725.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 7332.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 8984.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 9725.76, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 12041.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "475", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10498.58, "maximum": 27985.95, "estimated_discounted_cash": 93991.66, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 10498.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 23228.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 27985.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 27985.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 25187.57, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 25247.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 13895.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 10498.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 12837.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 13895.88, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 17204.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "474", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16006.64, "maximum": 50653.0, "estimated_discounted_cash": 73343.89, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 16006.64, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 41685.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 50222.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 50222.86, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 45200.96, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 50653.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 28887.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 16006.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 26686.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 28887.43, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 35765.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "476", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5648.04, "maximum": 15186.47, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 5648.04, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12604.97, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 15186.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 15186.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13667.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 13854.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7491.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5648.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6921.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7491.91, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9275.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26951", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 6351.96, "estimated_discounted_cash": 15112.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4585.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6351.96, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6351.96, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 4973.53, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 9961.33, "count": "1 through 10", "median_amount": 9961.33, "methodology": "percent of total billed charges", "10th_percentile": 9961.33, "90th_percentile": 9961.33}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26952", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 9340.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6743.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7313.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27888", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27889", "type": "CPT"}], "standard_charges": [{"minimum": 3153.25, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3153.25, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11587.76, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3153.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6591.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25900", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25905", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25915", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF HAND", "code_information": [{"code": "25927", "type": "CPT"}], "standard_charges": [{"minimum": 6743.02, "maximum": 9340.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6743.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9340.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7313.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27290", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27295", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27880", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27881", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "617", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8656.99, "maximum": 27276.1, "estimated_discounted_cash": 63700.49, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 8656.99, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 22639.52, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 27276.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 27276.1, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 24548.7, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 23362.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12442.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 8656.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11494.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12442.07, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 15404.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [{"code": "616", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15464.79, "maximum": 52563.04, "estimated_discounted_cash": 53440.86, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 15464.79, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 43628.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 52563.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 52563.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 47307.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 46590.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24895.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 15464.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22998.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24895.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 30823.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "618", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6046.26, "maximum": 15321.68, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 6046.26, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12717.19, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 15321.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 15321.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13789.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 13673.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8020.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 6046.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7409.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8020.1, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 9929.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF MIDFOOT", "code_information": [{"code": "28800", "type": "CPT"}], "standard_charges": [{"minimum": 8267.66, "maximum": 11452.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8267.66, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11452.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11452.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8967.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF TOE", "code_information": [{"code": "28820", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 8314.48, "estimated_discounted_cash": 10968.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6002.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8314.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8314.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6510.17, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_percentage": 36.0, "possible_amount": 3440.17, "count": "1 through 10", "median_amount": 3440.17, "methodology": "percent of total billed charges", "10th_percentile": 3440.17, "90th_percentile": 3440.17}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24900", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24920", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION THRU METATARSAL", "code_information": [{"code": "28805", "type": "CPT"}], "standard_charges": [{"minimum": 2993.75, "maximum": 11452.69, "estimated_discounted_cash": 13231.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8267.66, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11452.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11452.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8967.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION TOE & METATARSAL", "code_information": [{"code": "28810", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 11452.69, "estimated_discounted_cash": 12297.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8267.66, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11452.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11452.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8967.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTEE KNEE ORTHOSIS", "code_information": [{"code": "771020480", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1418.03, "discounted_cash": 1772.54, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMS 700", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "771026536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7934.23, "maximum": 20276.38, "gross_charge": 22039.55, "discounted_cash": 27549.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8154.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8154.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8154.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 16529.66, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 16529.66, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 20276.38, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7934.23, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 16529.66, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMS 700 100CC", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "771026538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3517.16, "maximum": 8988.3, "gross_charge": 9769.9, "discounted_cash": 12212.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3614.86, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3614.86, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3614.86, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7327.42, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7327.42, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 8988.3, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3517.16, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7327.42, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMS 700 LGX MS PUMP IZ", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "771037869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17095.77, "maximum": 43689.2, "gross_charge": 47488.27, "discounted_cash": 59360.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 17570.65, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 17570.65, "methodology": "percent of total billed charges"}, 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"plan_name": "PPO", "standard_charge_dollar": 171.93, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 67.28, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 140.16, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMYLASE, URINE 24 HR", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "701101295", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.29, "maximum": 131.92, "gross_charge": 143.4, "discounted_cash": 179.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 94.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 94.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 94.64, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 107.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 107.55, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 131.92, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 51.62, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 107.55, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMYLASE, URINE RANDOM", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "701101240", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.29, "maximum": 98.27, "gross_charge": 106.82, "discounted_cash": 133.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 70.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 70.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 70.5, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 80.11, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 80.11, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 98.27, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 38.45, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 80.11, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANA ANTINUCLEAR TITER - MISC CHRG", "code_information": [{"code": "86039", "type": "CPT"}, {"code": "701807452", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.83, "maximum": 73.75, "gross_charge": 80.17, "discounted_cash": 100.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 52.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 52.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 52.91, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 60.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 60.12, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 73.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 11.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 11.72, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 28.86, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 60.12, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANA CROWN EXP 1-3 PER QUAD", "code_information": [{"code": "D4231", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.0, "maximum": 1479.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1366.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANA CROWN EXP 4 OR> PER QUAD", "code_information": [{"code": "D4230", "type": "HCPCS"}], "standard_charges": [{"minimum": 756.0, "maximum": 3239.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3239.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2992.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3239.11, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANA SCREEN", "code_information": [{"code": "86038", "type": "CPT"}, {"code": "701807006", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.73, "maximum": 287.05, "gross_charge": 312.02, "discounted_cash": 390.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 205.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 205.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 205.93, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 234.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 234.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.11, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 287.05, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 112.32, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 234.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANA WITH PANEL IF POSITIVE", "code_information": [{"code": "86038", "type": "CPT"}, {"code": "701807000", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.73, "maximum": 287.05, "gross_charge": 312.02, "discounted_cash": 390.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 205.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 205.93, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 205.93, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 234.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 234.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.11, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 287.05, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 112.32, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 234.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 1 OR 2", "code_information": [{"code": "80327", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 3 OR MORE", "code_information": [{"code": "80328", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANACAULASE-BCDB 8.8% GEL 1 G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7353", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.69, "maximum": 56.92, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 52.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANACAULASE-BCDB 8.8% GEL 1 G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7353", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANACAULASE-BCDB 8.8% GEL 1 G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7353", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAEROBE (E-SWAB)", "code_information": [{"code": "771040381", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.23, "discounted_cash": 22.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANAEROBIC ID - CHRG ONLY", "code_information": [{"code": "87076", "type": "CPT"}, {"code": "701904952", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.84, "maximum": 196.57, "gross_charge": 213.67, "discounted_cash": 267.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 141.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 141.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 141.02, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 160.25, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 160.25, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 10.1, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 196.57, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8.48, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 76.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 160.25, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [{"code": "348", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6743.93, "maximum": 18361.31, "estimated_discounted_cash": 59530.33, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 6743.93, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 15240.13, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 18361.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 18361.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 16525.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15320.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 8108.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 6743.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 7491.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 8108.99, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 10039.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [{"code": "347", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12096.67, "maximum": 34187.43, "estimated_discounted_cash": 61200.24, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 12096.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28376.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34187.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34187.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 30768.95, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 30008.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 15245.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 12096.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 14083.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 15245.34, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 18875.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "349", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4661.69, "maximum": 13193.41, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 4661.69, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 10950.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13193.41, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13193.41, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 11874.17, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11487.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5674.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 4661.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5241.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5674.17, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7025.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL PRESSURE RECORD", "code_information": [{"code": "91122", "type": "CPT"}], "standard_charges": [{"minimum": 155.69, "maximum": 523.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 523.36, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 287.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}], "standard_charges": [{"minimum": 58.1, "maximum": 483.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 483.8, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 276.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51784", "type": "CPT"}], "standard_charges": [{"minimum": 23.82, "maximum": 349.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 23.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 252.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 349.87, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 349.87, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 273.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 253.01, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 156.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 23.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 144.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 156.27, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}], "standard_charges": [{"minimum": 117.39, "maximum": 1844.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1331.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1844.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1844.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1443.92, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 400.32, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 242.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 224.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 242.92, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALGESIA", "code_information": [{"code": "D9230", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.0, "maximum": 66.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 3-5", "code_information": [{"code": "80330", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 6/MORE", "code_information": [{"code": "80331", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYSIS NERVE", "code_information": [{"code": "88356", "type": "CPT"}], "standard_charges": [{"minimum": 49.3, "maximum": 546.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 77.45, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 53.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 53.36, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYSIS OF SALIVA SAMPLE", "code_information": [{"code": "D0418", "type": "HCPCS"}], "standard_charges": [{"minimum": 131.0, "maximum": 307.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 307.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 307.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 307.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 307.34, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 131.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYSIS TUMOR", "code_information": [{"code": "88358", "type": "CPT"}], "standard_charges": [{"minimum": 158.11, "maximum": 546.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 244.11, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 158.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYZE OF PROGM IMPLANT", "code_information": [{"code": "62368", "type": "CPT"}, {"code": "657002358", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 17.43, "maximum": 2055.42, "gross_charge": 2234.16, "discounted_cash": 2792.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 17.43, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1474.54, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1474.54, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1474.54, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1675.62, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1675.62, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 483.8, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2055.42, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 17.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 276.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 804.29, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1675.62, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYZE PACEMAKER SYSTEM", "code_information": [{"code": "93724", "type": "CPT"}], "standard_charges": [{"minimum": 85.38, "maximum": 483.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 483.8, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 276.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYZE SP INF PUMP W/REPROG", "code_information": [{"code": "62368", "type": "CPT"}, {"code": "801520408", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 17.43, "maximum": 483.8, "gross_charge": 49.29, "discounted_cash": 61.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 17.43, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 32.53, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 32.53, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 32.53, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 36.96, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 36.96, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 483.8, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 45.34, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 17.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 276.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 17.74, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 36.96, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYZE SPINE INFUS PUMP", "code_information": [{"code": "62367", "type": "CPT"}], "standard_charges": [{"minimum": 85.38, "maximum": 483.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 483.8, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 276.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAPLSMA PHGCYTOPHLM AMP PRB", "code_information": [{"code": "87468", "type": "CPT"}], "standard_charges": [{"minimum": 34.04, "maximum": 93.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 93.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 43.86, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 36.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 34.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 36.84, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANASCR, IFA RFX TITER and PATT", "code_information": [{"code": "86038", "type": "CPT"}, {"code": "7014D6316", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.73, "maximum": 31.24, "gross_charge": 33.96, "discounted_cash": 42.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 22.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 22.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 22.41, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 25.47, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 25.47, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.11, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 31.24, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 12.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 25.47, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANASTO CLIP", "code_information": [{"code": "771036084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2585.43, "discounted_cash": 3231.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANASTO CLIP REMOVER LEMAITRE", "code_information": [{"code": "771032490", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 907.68, "discounted_cash": 1134.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANASTOMOSIS/ARTERY-AORTA", "code_information": [{"code": "33606", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANASTROZOLE 1 MG", "code_information": [{"code": "S0170", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 14.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANATOMIC MULTIPLANER 4A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771039036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7173.62, "maximum": 18332.59, "gross_charge": 19926.73, "discounted_cash": 24908.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 7372.89, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 7372.89, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 7372.89, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 14945.04, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 14945.04, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 18332.59, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7173.62, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 14945.04, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANATOMIC PROXIMAL BODY 136 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2236.59, "maximum": 5715.74, "gross_charge": 6212.77, "discounted_cash": 7765.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2298.72, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2298.72, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2298.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4659.57, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4659.57, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5715.74, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2236.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4659.57, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANATOMIC RADIAL HEAD SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771037025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3810.44, "maximum": 9737.79, "gross_charge": 10584.56, "discounted_cash": 13230.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3916.28, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3916.28, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3916.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7938.42, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7938.42, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 9737.79, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3810.44, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7938.42, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANBX 30 PRIOR TO EPISODE", "code_information": [{"code": "G9703", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCA SCREEN", "code_information": [{"code": "86021", "type": "CPT"}, {"code": "7014D6292", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.6, "maximum": 157.3, "gross_charge": 170.98, "discounted_cash": 213.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 112.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 112.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 112.84, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 128.23, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 128.23, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 18.81, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 157.3, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 61.55, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 128.23, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCA SCREEN EACH ANTIBODY", "code_information": [{"code": "86036", "type": "CPT"}], "standard_charges": [{"minimum": 11.69, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCA TITER EACH ANTIBODY", "code_information": [{"code": "86037", "type": "CPT"}], "standard_charges": [{"minimum": 11.69, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCA VASCULITIS", "code_information": [{"code": "86021", "type": "CPT"}, {"code": "7014D6293", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.6, "maximum": 157.3, "gross_charge": 170.98, "discounted_cash": 213.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 112.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 112.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 112.84, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 128.23, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 128.23, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 18.81, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 157.3, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 61.55, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 128.23, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR 1.3 FLEX Y-KNOT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 575.58, "maximum": 1470.94, "gross_charge": 1598.85, "discounted_cash": 1998.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 591.57, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 591.57, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 591.57, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1199.13, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1199.13, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1470.94, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 575.58, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1199.13, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR 1.8 FLEX Y-KNOT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771036972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 616.69, "maximum": 1576.0, "gross_charge": 1713.05, "discounted_cash": 2141.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 633.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 633.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 633.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1284.78, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1284.78, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1576.0, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 616.69, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1284.78, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR 2 SUTURE 1.8 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771038077", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 465.44, "maximum": 1189.45, "gross_charge": 1292.89, "discounted_cash": 1616.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 478.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 478.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 478.36, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 969.66, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 969.66, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1189.45, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 465.44, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 969.66, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR 2 SUTURE 2.5 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771038076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 465.44, 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"payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 992.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 992.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 992.48, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2011.78, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2011.78, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2467.78, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 965.65, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2011.78, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE TAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771033295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 946.94, "maximum": 2419.96, "gross_charge": 2630.4, "discounted_cash": 3288.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 973.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 973.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 973.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1972.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1972.8, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2419.96, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 946.94, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1972.8, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771031840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.03, "maximum": 2310.32, "gross_charge": 2511.22, "discounted_cash": 3139.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 929.15, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 929.15, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 929.15, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1883.41, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1883.41, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2310.32, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 904.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1883.41, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR VERSALOOP 1.5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771038043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 465.44, "maximum": 1189.45, "gross_charge": 1292.89, "discounted_cash": 1616.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 478.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 478.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 478.36, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 969.66, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 969.66, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1189.45, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 465.44, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 969.66, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR/SCREW BN/BN,TIS/BN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 11422.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR/SCREW BN/BN,TIS/BN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 11422.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR/SCREW BN/BN,TIS/BN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 11422.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCURE 15CM SHEARTH", "code_information": [{"code": "771021036", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1304.78, "discounted_cash": 1630.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANDROLOGY INFERTILITY ASSMT", "code_information": [{"code": "255U", "type": "CPT"}], "standard_charges": [{"minimum": 30.65, "maximum": 546.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 546.35, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 33.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 33.18, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANDROSTANEDIOL GLUCURONIDE", "code_information": [{"code": "82154", "type": "CPT"}], "standard_charges": [{"minimum": 27.97, "maximum": 71.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 71.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 36.04, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 30.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 27.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 30.27, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANEMIA PLAN OF CARE DOCD", "code_information": [{"code": "516F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES C HYST FLWG NEURAXIAL", "code_information": [{"code": "1969", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN DELIVERY ONLY", "code_information": [{"code": "1961", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN HYSTERECTOMY", "code_information": [{"code": "1963", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES COMP CTRLD HYPOTENSION", "code_information": [{"code": "99135", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES COMP EMERGENCY COND", "code_information": [{"code": "99140", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES COMP TOT BDY HYPTHRM", "code_information": [{"code": "99116", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR CRV/THRC", "code_information": [{"code": "1937", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR LMBR/SAC", "code_information": [{"code": "1938", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES DX SHOULDER ARTHROSCOPY", "code_information": [{"code": "1622", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES END, 1 TEMP >35.5(95.9)", "code_information": [{"code": "G9771", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR DIPHRG HRNA", "code_information": [{"code": "756", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR LMBR&VNT&/DEHS", "code_information": [{"code": "752", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR OMPHALOCELE", "code_information": [{"code": "754", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR UPR ABD NOS", "code_information": [{"code": "750", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES INCOMPL/MISSED AB PX", "code_information": [{"code": "1965", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES INDUCED ABORTION PX", "code_information": [{"code": "1966", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD GSTR PX MO", "code_information": [{"code": "797", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD LVR TRNSPL", "code_information": [{"code": "796", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD NOS", "code_information": [{"code": "790", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PNCRTECT", "code_information": [{"code": "794", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PRTL HPTC", "code_information": [{"code": "792", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST NDSC NOS", "code_information": [{"code": "811", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST SCR COLSC", "code_information": [{"code": "812", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES MATERIALS LOCAL IN ER", "code_information": [{"code": "664022500", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 53.37, "discounted_cash": 66.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANES MEDIASCPY & DX THORSCPY", "code_information": [{"code": "528", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES MEDSCPY&THORSCPY 1 LUNG", "code_information": [{"code": "529", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT CRV/THRC", "code_information": [{"code": "1941", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT LMBR/SAC", "code_information": [{"code": "1942", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT CRV/THRC", "code_information": [{"code": "1939", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT LMBR/SAC", "code_information": [{"code": "1940", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES ORAL RAE 5.0 ET TUBE UNCUFFE", "code_information": [{"code": "771016460", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 47.76, "discounted_cash": 59.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANES PT EXTEME AGE<1 YR&>70", "code_information": [{"code": "99100", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES PX MAJ ABD BLOOD VESSEL", "code_information": [{"code": "770", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES SET UP", "code_information": [{"code": "664022505", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 400.44, "discounted_cash": 500.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANES SPINE TRANSTHOR W/VENT", "code_information": [{"code": "626", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANTHOR W/O VENT", "code_information": [{"code": "625", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES STYLET 4.6-6.0 43160-992", "code_information": [{"code": "771016521", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 31.3, "discounted_cash": 39.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANES STYLET 5.0-10.0 43160-994", "code_information": [{"code": "771016522", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 39.32, "discounted_cash": 49.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANES STYLET PEDI 6 FR 43160-990", "code_information": [{"code": "771019281", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 31.3, "discounted_cash": 39.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD ARTRL", "code_information": [{"code": "1924", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD CARD", "code_information": [{"code": "1925", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD TIPS", "code_information": [{"code": "1931", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD VEIN", "code_information": [{"code": "1930", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD CRAN VEIN", "code_information": [{"code": "1933", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD HRT/CRAN", "code_information": [{"code": "1926", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD TH VEIN", "code_information": [{"code": "1932", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX ERCP", "code_information": [{"code": "732", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX NOS", "code_information": [{"code": "731", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES UPR LWR GI NDSC PX", "code_information": [{"code": "813", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES URGENT HYSTERECTOMY", "code_information": [{"code": "1962", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES VAGINAL DELIVERY ONLY", "code_information": [{"code": "1960", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES XTRNL CEPHALIC VERSION", "code_information": [{"code": "1958", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES/ANALG CS DLVR NEURAXIAL", "code_information": [{"code": "1968", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH 60 MIN/> AS DOCD", "code_information": [{"code": "4255F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMEN VESSEL SURG", "code_information": [{"code": "880", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "700", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "730", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "800", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "820", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ACHILLES TENDON SURG", "code_information": [{"code": "1472", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMNIOCENTESIS", "code_information": [{"code": "842", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT KNEE", "code_information": [{"code": "1404", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT PELVIS", "code_information": [{"code": "1140", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF FEMUR", "code_information": [{"code": "1232", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF PENIS", "code_information": [{"code": "932", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE REPLACEMENT", "code_information": [{"code": "1486", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE/FT ARTHROSCOPY", "code_information": [{"code": "1464", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ANORECTAL SURGERY", "code_information": [{"code": "902", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ARM-LEG VESSEL SURG", "code_information": [{"code": "1656", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ARTHROSCOPY OF HIP", "code_information": [{"code": "1202", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BICEPS TENDON REPAIR", "code_information": [{"code": "1716", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF NOSE", "code_information": [{"code": "164", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF THYROID", "code_information": [{"code": "322", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER STONE SURG", "code_information": [{"code": "870", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER SURGERY", "code_information": [{"code": "910", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER TUMOR SURG", "code_information": [{"code": "912", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEEDING CONTROL", "code_information": [{"code": "916", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEPHAROPLASTY", "code_information": [{"code": "103", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BODY CAST PROCEDURE", "code_information": [{"code": "1130", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BONE ASPIRATE/BX", "code_information": [{"code": "1112", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN 4-9 PERCENT", "code_information": [{"code": "1952", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN EACH 9 PERCENT", "code_information": [{"code": "1953", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN LESS 4 PERCENT", "code_information": [{"code": "1951", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/O PUMP", "code_information": [{"code": "566", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/PUMP", "code_information": [{"code": "567", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIAC ELECTROPHYS", "code_information": [{"code": "537", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIOVERTER/DEFIB", "code_information": [{"code": "534", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CAT OR MRI SCAN", "code_information": [{"code": "1922", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CATHETERIZE HEART", "code_information": [{"code": "1920", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST DRAINAGE", "code_information": [{"code": "524", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST LINING BIOPSY", "code_information": [{"code": "522", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST PROCEDURE", "code_information": [{"code": "520", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST SURGERY", "code_information": [{"code": "540", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST WALL REPAIR", "code_information": [{"code": "472", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CLEFT PALATE REPAIR", "code_information": [{"code": "172", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH COLLAR BONE BIOPSY", "code_information": [{"code": "454", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CORNEAL TRANSPLANT", "code_information": [{"code": "144", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CORRECT HEART RHYTHM", "code_information": [{"code": "410", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CRAN SURG HEMOTOMA", "code_information": [{"code": "211", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CRANIAL SURG NOS", "code_information": [{"code": "210", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ARTERIOGRAPHY", "code_information": [{"code": "1916", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ELBOW ARTHROSCOPY", "code_information": [{"code": "1732", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH DX KNEE ARTHROSCOPY", "code_information": [{"code": "1382", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH DX WRIST ARTHROSCOPY", "code_information": [{"code": "1829", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR EXAM", "code_information": [{"code": "124", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR SURGERY", "code_information": [{"code": "120", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW AREA SURGERY", "code_information": [{"code": "1710", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW REPLACEMENT", "code_information": [{"code": "1760", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ELECTROSHOCK", "code_information": [{"code": "104", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ESOPHAGEAL SURGERY", "code_information": [{"code": "500", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH EYE EXAM", "code_information": [{"code": "148", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FACE/SKULL BONE SURG", "code_information": [{"code": "190", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FACIAL BONE SURGERY", "code_information": [{"code": "192", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FAT LAYER REMOVAL", "code_information": [{"code": "802", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL ARTERY SURG", "code_information": [{"code": "1272", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL EMBOLECTOMY", "code_information": [{"code": "1274", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FOR LIVER BIOPSY", "code_information": [{"code": "702", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FOREQUARTER AMPUT", "code_information": [{"code": "1636", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FX REPAIR PELVIS", "code_information": [{"code": "1173", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH GENITALIA SURGERY", "code_information": [{"code": "920", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD NERVE SURGERY", "code_information": [{"code": "222", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD VESSEL SURGERY", "code_information": [{"code": "216", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD/NECK/PTRUNK", "code_information": [{"code": "300", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG <1 YR", "code_information": [{"code": "561", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/ARREST", "code_information": [{"code": "563", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/O PUMP", "code_information": [{"code": "560", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART/LUNG TRANSPLNT", "code_information": [{"code": "580", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR < 1 YR", "code_information": [{"code": "834", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR PREEMIE", "code_information": [{"code": "836", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP ARTHROPLASTY", "code_information": [{"code": "1214", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP DISARTICULATION", "code_information": [{"code": "1212", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT PROCEDURE", "code_information": [{"code": "1200", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT SURGERY", "code_information": [{"code": "1210", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HRT SURG W/PMP AGE 1+", "code_information": [{"code": "562", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERAL LESION SURG", "code_information": [{"code": "1758", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERUS REPAIR", "code_information": [{"code": "1744", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERUS SURGERY", "code_information": [{"code": "1742", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTERECTOMY", "code_information": [{"code": "846", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTEROSCOPE/GRAPH", "code_information": [{"code": "952", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH INSERT PENIS DEVICE", "code_information": [{"code": "938", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH INTRCRN NERVE", "code_information": [{"code": "220", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH IRIDECTOMY", "code_information": [{"code": "147", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY STONE DESTRUCT", "code_information": [{"code": "872", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY STONE DESTRUCT", "code_information": [{"code": "873", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY TRANSPLANT", "code_information": [{"code": "868", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY/URETER SURG", "code_information": [{"code": "862", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1340", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1390", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1320", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1360", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1392", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERIES SURG", "code_information": [{"code": "1440", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY REPAIR", "code_information": [{"code": "1444", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY SURG", "code_information": [{"code": "1442", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTHROPLASTY", "code_information": [{"code": "1402", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT CASTING", "code_information": [{"code": "1420", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT PROCEDURE", "code_information": [{"code": "1380", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT SURGERY", "code_information": [{"code": "1400", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VEINS SURGERY", "code_information": [{"code": "1430", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VESSEL SURG", "code_information": [{"code": "1432", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LARYNX/TRACH < 1 YR", "code_information": [{"code": "326", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LEG ARTERIES SURG", "code_information": [{"code": "1500", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LENS SURGERY", "code_information": [{"code": "142", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM CASTING", "code_information": [{"code": "1860", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM PROCEDURE", "code_information": [{"code": "1820", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1810", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1830", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM VEIN SURG", "code_information": [{"code": "1850", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG BONE SURG", "code_information": [{"code": "1480", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG CASTING", "code_information": [{"code": "1490", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG PROCEDURE", "code_information": [{"code": "1462", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG REVISION", "code_information": [{"code": "1484", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG SURGERY", "code_information": [{"code": "1470", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG SURGERY", "code_information": [{"code": "1474", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1520", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1522", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LUMBAR PUNCTURE", "code_information": [{"code": "635", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LUNG CHEST WALL SURG", "code_information": [{"code": "546", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM ARTERY SURG", "code_information": [{"code": "1840", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM EMBOLECTOMY", "code_information": [{"code": "1842", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM VEIN REPAIR", "code_information": [{"code": "1852", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR LEG EMBOLECTOMY", "code_information": [{"code": "1502", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH MAJOR VEIN LIGATION", "code_information": [{"code": "882", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH N BLOCK/INJ PRONE", "code_information": [{"code": "1992", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK ORGAN 1YR/>", "code_information": [{"code": "320", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "350", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "352", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NERVE BLOCK/INJ", "code_information": [{"code": "1991", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NOSE/SINUS SURGERY", "code_information": [{"code": "160", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NOSE/SINUS SURGERY", "code_information": [{"code": "162", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ONE LUNG VENTILATION", "code_information": [{"code": "541", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PACEMAKER INSERTION", "code_information": [{"code": "530", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC ORGAN SURG", "code_information": [{"code": "848", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC TUMOR SURGERY", "code_information": [{"code": "1150", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS PROCEDURE", "code_information": [{"code": "1160", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1120", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1170", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "844", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "934", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "936", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PERINEAL SURGERY", "code_information": [{"code": "904", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "174", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "176", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON FEMUR", "code_information": [{"code": "1220", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON MOUTH", "code_information": [{"code": "170", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURES ON EYE", "code_information": [{"code": "140", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL FEMUR SURG", "code_information": [{"code": "1234", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL HUMERUS SURG", "code_information": [{"code": "1756", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL LEG SURGERY", "code_information": [{"code": "1482", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF ADRENAL", "code_information": [{"code": "866", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF BLADDER", "code_information": [{"code": "864", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF NERVES", "code_information": [{"code": "632", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "865", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "908", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "914", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF RIB", "code_information": [{"code": "470", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "926", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "928", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF VULVA", "code_information": [{"code": "906", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CERVIX", "code_information": [{"code": "948", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CLEFT LIP", "code_information": [{"code": "102", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "830", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "832", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REVISE HIP REPAIR", "code_information": [{"code": "1215", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SALIVARY GLAND", "code_information": [{"code": "100", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER ARTERY SURG", "code_information": [{"code": "1650", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER CASTING", "code_information": [{"code": "1680", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER JOINT AMPUT", "code_information": [{"code": "1634", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER PROCEDURE", "code_information": [{"code": "1620", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER REPLACEMENT", "code_information": [{"code": "1638", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VEIN SURG", "code_information": [{"code": "1670", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1652", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1654", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SITTING PROCEDURE", "code_information": [{"code": "604", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKIN EXT/PER/ATRUNK", "code_information": [{"code": "400", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "212", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "214", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL REPAIR/FRACT", "code_information": [{"code": "215", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPECIAL HEAD SURGERY", "code_information": [{"code": "218", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPERM DUCT SURGERY", "code_information": [{"code": "922", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "600", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "620", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "630", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "670", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE MANIPULATION", "code_information": [{"code": "640", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH STERNAL DEBRIDEMENT", "code_information": [{"code": "550", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH STONE REMOVAL", "code_information": [{"code": "918", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG LOWER ABDOMEN", "code_information": [{"code": "840", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG ON VAG/URETHRAL", "code_information": [{"code": "942", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF ABDOMEN", "code_information": [{"code": "860", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "402", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "404", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "406", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF FEMUR", "code_information": [{"code": "1230", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF RIB", "code_information": [{"code": "474", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "1610", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "1630", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "450", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TESTIS EXPLORATION", "code_information": [{"code": "924", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TESTIS SUSPENSION", "code_information": [{"code": "930", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH THIGH ARTERIES SURG", "code_information": [{"code": "1270", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TRACH-BRONCH RECONST", "code_information": [{"code": "539", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TRACHEA BRONCHI SURG", "code_information": [{"code": "548", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TUBAL LIGATION", "code_information": [{"code": "851", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TYMPANOTOMY", "code_information": [{"code": "126", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER ARM SURGERY", "code_information": [{"code": "1740", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER ARM VEIN SURG", "code_information": [{"code": "1780", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG SURGERY", "code_information": [{"code": "1250", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG VEINS SURG", "code_information": [{"code": "1260", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM ARTERY SURG", "code_information": [{"code": "1770", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM EMBOLECTOMY", "code_information": [{"code": "1772", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM PROCEDURE", "code_information": [{"code": "1730", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1712", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1714", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM VEIN REPAIR", "code_information": [{"code": "1782", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL ENDOSCOPY", "code_information": [{"code": "950", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL HYSTERECTOMY", "code_information": [{"code": "944", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL PROCEDURES", "code_information": [{"code": "940", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR ACCESS", "code_information": [{"code": "532", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR SHUNT SURG", "code_information": [{"code": "1844", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VASECTOMY", "code_information": [{"code": "921", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VITREORETINAL SURG", "code_information": [{"code": "145", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH W/O GEN/NEURAX ANESTH", "code_information": [{"code": "4560F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH WRIST REPLACEMENT", "code_information": [{"code": "1832", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHE <60 MIN AS DOCD", "code_information": [{"code": "4256F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHESIA MACHINE MONITORING", "code_information": [{"code": "664022515", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 1221.04, "discounted_cash": 1526.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANESTHESIA REMOVAL PLEURA", "code_information": [{"code": "542", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHESIOLOGY SS", "code_information": [{"code": "G0061", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHETICS (GUS)", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "LABGA6021", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 73.59, "maximum": 188.06, "gross_charge": 204.42, "discounted_cash": 255.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 188.06, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 73.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANETHESIA EACH 1/4 HR/PORTION", "code_information": [{"code": "664022520", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 75.86, "discounted_cash": 94.83, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANEURX STENT GRAFT, 12X12X85", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "771029313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7096.04, "maximum": 18134.33, "gross_charge": 19711.23, "discounted_cash": 24639.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 7293.15, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 7293.15, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 7293.15, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 14783.42, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 14783.42, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 18134.33, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7096.04, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 14783.42, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANEURYMS CLIP 20-1253", "code_information": [{"code": "771008664", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1139.4, "discounted_cash": 1424.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANEWRX STENT GRAFT 18X18X115", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "771029312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7758.7, "maximum": 19827.81, "gross_charge": 21551.97, "discounted_cash": 26939.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 7974.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 7974.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 7974.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 16163.97, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 16163.97, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 19827.81, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7758.7, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 16163.97, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGEL CPRP SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771037236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 462.03, "maximum": 1180.75, "gross_charge": 1283.43, "discounted_cash": 1604.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 474.86, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 474.86, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 474.86, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 962.57, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 962.57, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1180.75, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 462.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 962.57, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGEL SYSTEM W/ASPIRATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771037235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1534.91, "maximum": 3922.56, "gross_charge": 4263.66, "discounted_cash": 5329.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1577.55, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1577.55, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1577.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3197.74, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3197.74, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3922.56, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1534.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3197.74, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIASSIST DELIVERY SYS", "code_information": [{"code": "771042361", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 719.41, "discounted_cash": 899.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGINA ABSENT", "code_information": [{"code": "1012F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGINA PECTORIS", "code_information": [{"code": "311", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2919.4, "maximum": 8831.58, "estimated_discounted_cash": 19102.27, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 2919.4, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7330.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8831.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8831.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7948.49, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8218.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4497.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2919.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4155.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4497.98, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5568.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGINA PRESENT", "code_information": [{"code": "1011F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIO FEM/POP W/ US", "code_information": [{"code": "C7531", "type": "HCPCS"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIO KIT 6FR", "code_information": [{"code": "771005478", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 437.96, "discounted_cash": 547.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGIO THRU EXISTING CATHERTER", "code_information": [{"code": "75898", "type": "CPT"}, {"code": "704307511", "type": "CDM"}, {"code": "321", "type": "RC"}], "standard_charges": [{"minimum": 553.89, "maximum": 5162.92, "gross_charge": 1538.61, "discounted_cash": 1923.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1426.88, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1015.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1015.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1015.48, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 685.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 949.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 949.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 743.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1153.95, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1153.95, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5162.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1415.52, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1426.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 553.89, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1153.95, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIO W/ US NON-CORONARY", "code_information": [{"code": "C7532", "type": "HCPCS"}], "standard_charges": [{"minimum": 25319.47, "maximum": 35073.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 25319.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 35073.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 35073.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 27462.29, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIO, 5FR PIGTAIL W/C MARKERS", "code_information": [{"code": "771022267", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1184.09, "discounted_cash": 1480.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGIO-SEAL 6F", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "771027650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 370.41, "maximum": 946.61, "gross_charge": 1028.93, "discounted_cash": 1286.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 380.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 380.7, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 380.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 771.69, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 771.69, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 946.61, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 370.41, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 771.69, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOCATH 14 GA 5 1/4", "code_information": [{"code": "771025174", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 35.81, "discounted_cash": 44.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGIOCATH 18 GA 2IN", "code_information": [{"code": "771016072", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.94, "discounted_cash": 22.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGIOCATH 20GA 2IN", "code_information": [{"code": "771007407", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.23, "discounted_cash": 54.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGIOGRAPHY AORTIC ARCH TC", "code_information": [{"code": "36221", "type": "CPT"}, {"code": "713550095", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1420.91, "maximum": 8073.31, "gross_charge": 3946.99, "discounted_cash": 4933.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2960.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2960.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5162.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3631.23, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1420.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2960.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOGRAPHY EXP UNILATERAL TC", "code_information": [{"code": "75710", "type": "CPT"}, {"code": "713550140", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 250.5, "maximum": 6074.02, "gross_charge": 3946.99, "discounted_cash": 4933.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2960.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2960.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6074.02, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3631.23, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1420.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2960.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOGRAPHY INTERNAL CAROITD T", "code_information": [{"code": "36224", "type": "CPT"}, {"code": "713550120", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 2673.4, "maximum": 8901.06, "gross_charge": 7426.12, "discounted_cash": 9282.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 4901.23, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4901.23, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4901.23, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 5569.59, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 5569.59, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8901.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 6832.03, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5399.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4987.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5399.11, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2673.4, "methodology": "percent of total billed charges"}, {"payer_name": "United 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"methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 2522.91, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2522.91, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5162.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3094.76, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1210.99, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 2522.91, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOGUARD 6.0 MM", "code_information": [{"code": "771027739", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8821.42, "discounted_cash": 11026.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGIOGUARD RX 5.0MM", "code_information": [{"code": "771029682", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8321.62, "discounted_cash": 10402.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGIOJET SPIROFLEX RX 135CM", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "771027629", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 2912.16, "maximum": 7442.2, "gross_charge": 8089.35, "discounted_cash": 10111.69, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6067.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6067.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7442.2, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2912.16, "methodology": "percent of 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{"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 14388.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOPLASTY BOOKS", "code_information": [{"code": "771005436", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 44.65, "discounted_cash": 55.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGIOPLASTY SURGERY SETUP", "code_information": [{"code": "660020000", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"gross_charge": 7116.11, "discounted_cash": 8895.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANGIOPLASTY W/ STENT", "code_information": [{"code": "36906", "type": "CPT"}, {"code": "704309626", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 9473.03, "maximum": 28402.43, "gross_charge": 29077.88, "discounted_cash": 36347.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 10583.04, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 19191.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 19191.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 19191.4, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 21808.41, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 21808.41, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 28402.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 26751.64, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 17934.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 10583.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16568.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 17934.83, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 10468.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 21808.41, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOPLASTY W/CENTRAL BALLOON", "code_information": [{"code": "36907", "type": "CPT"}, {"code": "704309627", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 2867.14, "maximum": 13122.43, "gross_charge": 7964.28, "discounted_cash": 9955.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5256.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5256.42, "methodology": "percent of 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{"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7327.13, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2867.14, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 5973.21, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOPLASTY W/CENTRAL STENTS", "code_information": [{"code": "36908", "type": "CPT"}, {"code": "704309628", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 3012.32, "maximum": 13122.43, "gross_charge": 8367.56, "discounted_cash": 10459.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5522.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5522.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5522.58, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6275.67, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6275.67, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7698.15, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3012.32, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6275.67, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCOPY", "code_information": [{"code": "35400", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCULPT 014 2X100X155", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771041715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1896.41, "maximum": 4846.39, "gross_charge": 5267.82, "discounted_cash": 6584.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1949.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1949.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1949.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3950.86, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3950.86, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4846.39, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1896.41, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3950.86, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCULPT 014 3.5X100X155", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771042566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1831.16, "maximum": 4679.64, "gross_charge": 5086.57, "discounted_cash": 6358.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1882.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1882.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1882.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3814.92, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3814.92, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4679.64, "methodology": "percent of total 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2045.79, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4146.88, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4146.88, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5086.84, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1990.5, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4146.88, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCULPT 2.5X100X155", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771042155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1805.87, "maximum": 4615.01, "gross_charge": 5016.32, "discounted_cash": 6270.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1856.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1856.03, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1856.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3762.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3762.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4615.01, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1805.87, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3762.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCULPT 2X10X137", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771029583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2321.33, "maximum": 5932.3, "gross_charge": 6448.16, "discounted_cash": 8060.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2385.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2385.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2385.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4836.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4836.12, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5932.3, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2321.33, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4836.12, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCULPT 4X200X137", "code_information": [{"code": "C2623", "type": "HCPCS"}, {"code": "771043315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3317.34, "maximum": 8477.67, "gross_charge": 9214.86, "discounted_cash": 11518.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 6081.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 6081.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 6081.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6911.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6911.14, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 8477.67, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3317.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6911.14, "methodology": "percent of 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"percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4846.39, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1896.41, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3950.86, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCULPT 6.0X20", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771040424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1566.1, "maximum": 4002.25, "gross_charge": 4350.28, "discounted_cash": 5437.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1609.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1609.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1609.6, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3262.71, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3262.71, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4002.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1566.1, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3262.71, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCULPT 6X40X137 SCORING BALL", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.3, "maximum": 5814.65, "gross_charge": 6320.28, "discounted_cash": 7900.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2338.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2338.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2338.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4740.21, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4740.21, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5814.65, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2275.3, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4740.21, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCULPT EX 2.0X10", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2035.53, "maximum": 5201.91, "gross_charge": 5654.25, "discounted_cash": 7067.81, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2092.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2092.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2092.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4240.68, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4240.68, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5201.91, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2035.53, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 4240.68, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCULPT EX2.5X10", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2035.53, "maximum": 5201.91, "gross_charge": 5654.25, "discounted_cash": 7067.81, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2092.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2092.07, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2092.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 4240.68, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4240.68, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 5201.91, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2035.53, 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{"description": "ANGRIOGRAPHY COMMON CAROTID UNILA", "code_information": [{"code": "36222", "type": "CPT"}, {"code": "713550125", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1768.43, "maximum": 8073.31, "gross_charge": 4912.33, "discounted_cash": 6140.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3242.13, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3242.13, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3242.13, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3684.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3684.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5162.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 4519.34, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1768.43, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3684.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGRIOGRAPHY LOWER EXT BIL TC", "code_information": [{"code": "75716", "type": "CPT"}, {"code": "713550145", "type": "CDM"}, {"code": "321", "type": "RC"}], "standard_charges": [{"minimum": 250.5, "maximum": 7408.57, "gross_charge": 8052.8, "discounted_cash": 10066.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5314.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5314.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5314.84, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6039.6, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6039.6, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6074.02, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7408.57, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2899.0, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6039.6, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANIDULAFUNGIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0348", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.52, "maximum": 1.4, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANIDULAFUNGIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0348", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANIDULAFUNGIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0348", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29891", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 9829.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7095.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7696.29, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29892", "type": "CPT"}], "standard_charges": [{"minimum": 3153.25, "maximum": 11587.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3153.25, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7095.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7696.29, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11587.76, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3153.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6591.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29894", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 9829.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7095.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7696.29, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29895", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 9829.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7095.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7696.29, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29897", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 9829.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7095.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7696.29, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29898", "type": "CPT"}], "standard_charges": [{"minimum": 1418.32, "maximum": 9829.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7095.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9829.34, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7696.29, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1418.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29899", "type": "CPT"}], "standard_charges": [{"minimum": 3996.63, "maximum": 21628.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3996.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 15613.66, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 21628.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 21628.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 16935.06, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11587.76, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3996.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6591.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE BRACHIAL INDEX SNGLE", "code_information": [{"code": "93922", "type": "CPT"}, {"code": "714060030", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 118.93, "maximum": 426.57, "gross_charge": 463.67, "discounted_cash": 579.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 306.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 306.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 306.02, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 339.3, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 347.75, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 347.75, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 206.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 426.57, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 166.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 347.75, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE JOINTS-CUSTOM", "code_information": [{"code": "771024055", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1084.74, "discounted_cash": 1355.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANKLE KIT-RIGHT", "code_information": [{"code": "771020552", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"gross_charge": 17233.97, "discounted_cash": 21542.46, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANKLE, 2 VIEWS LT", "code_information": [{"code": "704107367", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 300.67, "discounted_cash": 375.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANL SP INF PMP W/MDREPRG & FIL", "code_information": [{"code": "62370", "type": "CPT"}, {"code": "657002359", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 50.84, "maximum": 2055.42, "gross_charge": 2234.16, "discounted_cash": 2792.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 50.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1474.54, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1474.54, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1474.54, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1675.62, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1675.62, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 483.8, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2055.42, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 50.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 276.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 804.29, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1675.62, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANL SP INF PMP W/MDREPRG & FIL", "code_information": [{"code": "62370", "type": "CPT"}, {"code": "801520033", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 46.08, "maximum": 483.8, "gross_charge": 128.02, "discounted_cash": 160.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 50.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 84.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 84.49, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 84.49, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 85.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 96.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 96.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 483.8, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 117.77, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 50.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 276.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 299.54, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 46.08, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 96.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANN BREAST EXAM", "code_information": [{"code": "S0613", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.45, "maximum": 66.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 66.45, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL ALCOHOL SCREEN 15 MIN", "code_information": [{"code": "G0442", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.49, "maximum": 41.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 41.01, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 27.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL GYNECOLOGICAL EXAMINA", "code_information": [{"code": "S0610", "type": "HCPCS"}], "standard_charges": [{"minimum": 159.09, "maximum": 159.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 159.09, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL GYNECOLOGICAL EXAMINA", "code_information": [{"code": "S0612", "type": "HCPCS"}], "standard_charges": [{"minimum": 110.69, "maximum": 110.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 110.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL WELLNESS VISIT, W/ PPS , SUB", "code_information": [{"code": "G0439", "type": "HCPCS"}, {"code": "800521160", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 165.47, "maximum": 422.87, "gross_charge": 459.65, "discounted_cash": 574.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 303.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 303.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 303.36, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 344.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 344.73, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 177.59, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 422.87, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 165.47, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 344.73, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL WELLNESS VISIT, W/ PPS, INITIAL", "code_information": [{"code": "G0438", "type": "HCPCS"}, {"code": "800521159", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 226.31, "maximum": 634.27, "gross_charge": 689.43, "discounted_cash": 861.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 455.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 455.02, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 455.02, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 517.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 517.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 226.31, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 634.27, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 248.19, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 517.07, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNULEX VERSACLOSE", "code_information": [{"code": "771031721", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4948.01, "discounted_cash": 6185.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANNULOPLASTY RING", "code_information": [{"code": "771026609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12698.31, "discounted_cash": 15872.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANNUPLASTY RING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771026429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5314.84, "maximum": 13582.38, "gross_charge": 14763.46, "discounted_cash": 18454.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5462.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5462.48, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5462.48, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 11072.59, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 11072.59, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 13582.38, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5314.84, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 11072.59, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOGENITAL EXAM CHILD W IMAG", "code_information": [{"code": "99170", "type": "CPT"}], "standard_charges": [{"minimum": 185.62, "maximum": 3186.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2300.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2495.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 294.28, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 200.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 185.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 200.93, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46611", "type": "CPT"}], "standard_charges": [{"minimum": 439.62, "maximum": 3186.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 439.62, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2300.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2495.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1480.38, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 910.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 439.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 841.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 910.6, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46615", "type": "CPT"}], "standard_charges": [{"minimum": 1255.58, "maximum": 4547.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1255.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2300.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2495.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4547.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 2739.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1255.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2530.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 2739.05, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND BIOPSY", "code_information": [{"code": "46606", "type": "CPT"}], "standard_charges": [{"minimum": 195.81, "maximum": 3186.95, "estimated_discounted_cash": 11050.22, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 195.81, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2300.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2495.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1911.41, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1177.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 195.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1087.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1177.64, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND DILATION", "code_information": [{"code": "46604", "type": "CPT"}], "standard_charges": [{"minimum": 155.69, "maximum": 1911.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1911.41, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1177.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1087.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1177.64, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY CONTROL BLEEDING", "code_information": [{"code": "46614", "type": "CPT"}], "standard_charges": [{"minimum": 1087.91, "maximum": 3186.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2300.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2495.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1911.41, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1177.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1087.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1177.64, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE FOR BODY", "code_information": [{"code": "46608", "type": "CPT"}], "standard_charges": [{"minimum": 439.62, "maximum": 3186.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 439.62, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2300.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2495.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1480.38, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 910.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 439.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 841.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 910.6, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESION", "code_information": [{"code": "46610", "type": "CPT"}], "standard_charges": [{"minimum": 1255.58, "maximum": 4547.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1255.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2300.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2495.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4547.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 2739.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1255.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2530.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 2739.05, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESIONS", "code_information": [{"code": "46612", "type": "CPT"}], "standard_charges": [{"minimum": 1255.58, "maximum": 4547.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1255.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2300.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3186.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2495.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4547.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 2739.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1255.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2530.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 2739.05, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANPHX DUE TO VAX", "code_information": [{"code": "M1219", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANS PARASYMP & SYMP W/TILT", "code_information": [{"code": "95924", "type": "CPT"}], "standard_charges": [{"minimum": 49.57, "maximum": 311.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 49.57, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 287.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANSEL 7F 55CM ST", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "771042652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 274.15, "maximum": 700.62, "gross_charge": 761.55, "discounted_cash": 951.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 281.77, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 281.77, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 281.77, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 571.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 571.16, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 700.62, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 274.15, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 571.16, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANSPACH DRILL BIT", "code_information": [{"code": "771026226", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 876.8, "discounted_cash": 1096.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANT RESIN-BASED CMPST CROWN", "code_information": [{"code": "D2390", "type": "HCPCS"}], "standard_charges": [{"minimum": 393.0, "maximum": 4388.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3167.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 4388.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 4388.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3435.85, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 393.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG I&R SPECLR MIC", "code_information": [{"code": "92286", "type": "CPT"}], "standard_charges": [{"minimum": 118.93, "maximum": 212.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 119.27, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 165.21, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 165.21, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 129.36, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 212.99, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG IR FLRSCN ANGRPH", "code_information": [{"code": "92287", "type": "CPT"}], "standard_charges": [{"minimum": 19.92, "maximum": 212.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 19.92, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 19.92, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 19.92, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 19.92, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 212.99, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG 8+", "code_information": [{"code": "22837", "type": "CPT"}], "standard_charges": [{"minimum": 35343.02, "maximum": 48958.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 35343.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 48958.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 48958.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 38334.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG <7", "code_information": [{"code": "22836", "type": "CPT"}], "standard_charges": [{"minimum": 35343.02, "maximum": 48958.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 35343.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 48958.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 48958.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 38334.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT/RETRO INF PRESS MONIT", "code_information": [{"code": "771029942", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 740.33, "discounted_cash": 925.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTB TP TOTAL&RPR IA QUAL", "code_information": [{"code": "64U", "type": "CPT"}], "standard_charges": [{"minimum": 30.39, "maximum": 48.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 30.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTENTIAL PERFUSION CANNULA 18FR", "code_information": [{"code": "771030912", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1537.2, "discounted_cash": 1921.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59425", "type": "CPT"}], "standard_charges": [{"minimum": 865.96, "maximum": 865.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 865.96, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59426", "type": "CPT"}], "standard_charges": [{"minimum": 1584.11, "maximum": 1584.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1584.11, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM MANAGEMENT", "code_information": [{"code": "H1001", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM MANIPULATION", "code_information": [{"code": "59412", "type": "CPT"}], "standard_charges": [{"minimum": 2933.7, "maximum": 5063.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5063.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3175.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2933.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3175.65, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTERIOR COLPORRHAPHY", "code_information": [{"code": "57240", "type": "CPT"}], "standard_charges": [{"minimum": 1998.9, "maximum": 10028.11, "estimated_discounted_cash": 100.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1998.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7239.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10028.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10028.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7851.92, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8056.47, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4930.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1998.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4554.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4930.43, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTERIOR GAIT TRAINER", "code_information": [{"code": "E8002", "type": "HCPCS"}], "standard_charges": [{"minimum": 2550.0, "maximum": 2550.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2550.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTERIOR TIBIALS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771031408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5388.3, "maximum": 13770.1, "gross_charge": 14967.5, "discounted_cash": 18709.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5537.97, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5537.97, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5537.97, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 11225.62, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 11225.62, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 13770.1, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5388.3, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 11225.62, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTERIOR VETRECTOMY PROBE", "code_information": [{"code": "771016061", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1304.78, "discounted_cash": 1630.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTEROLATERAL LIG. SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771037138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2585.24, "maximum": 6606.73, "gross_charge": 7181.23, "discounted_cash": 8976.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2657.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2657.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2657.05, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 5385.92, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 5385.92, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 6606.73, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2585.24, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 5385.92, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTHEM RF PULSE GEN", "code_information": [{"code": "C2621", "type": "HCPCS"}, {"code": "771040448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19671.95, "maximum": 50272.78, "gross_charge": 54644.33, "discounted_cash": 68305.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 20218.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 20218.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 20218.4, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 40983.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 40983.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 50272.78, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 19671.95, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 40983.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTHRAX VACCINE SC OR IM", "code_information": [{"code": "90581", "type": "CPT"}], "standard_charges": [{"minimum": 61.03, "maximum": 103.95, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 61.03, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 103.95, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTHRAX VACCINE SC OR IM", "code_information": [{"code": "90581", "type": "CPT"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTHRAX VACCINE SC OR IM", "code_information": [{"code": "90581", "type": "CPT"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI FOGG KIT", "code_information": [{"code": "771009749", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.94, "discounted_cash": 22.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTI FUNGAL SKIN CREAM", "code_information": [{"code": "771029302", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 73.05, "discounted_cash": 91.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTI MULLERIAN HORMONE-FEMALE", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "7014D6283", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.7, "maximum": 53.11, "gross_charge": 57.73, "discounted_cash": 72.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 38.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 38.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 38.1, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 43.29, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 43.29, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 53.11, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 13.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 20.78, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 43.29, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI MULLERIAN HORMONE-MALE", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "7014D6284", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.7, "maximum": 53.11, "gross_charge": 57.73, "discounted_cash": 72.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 38.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 38.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 38.1, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 43.29, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 43.29, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 53.11, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 13.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 20.78, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 43.29, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI RHEUM DRUGTHXPYRXD/GVN", "code_information": [{"code": "4187F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-EGFR MON ANTI THER", "code_information": [{"code": "G9839", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-INFLM/ANLGSC AGENT RX", "code_information": [{"code": "4016F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-INFLM/ANLGSC OTC ASSESS", "code_information": [{"code": "1007F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7198", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.4, "maximum": 2.61, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 2.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 2.35, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7198", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7198", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBIO RX W IN 10D OF SYMPT", "code_information": [{"code": "G9286", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBIOT NOT RXD/GIVEN", "code_information": [{"code": "4124F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBIOT RXD/GIVEN", "code_information": [{"code": "4120F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBIOTIC NOT PRES", "code_information": [{"code": "G8708", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY ABSORPTION - CHRG ONLY", "code_information": [{"code": "86975", "type": "CPT"}, {"code": "702503951", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 38.17, "maximum": 474.54, "gross_charge": 106.04, "discounted_cash": 132.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 69.98, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 69.98, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 69.98, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 79.53, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 79.53, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 474.54, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 97.55, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 398.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 368.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 398.55, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 38.17, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 79.53, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY DETECTION NOS IF", "code_information": [{"code": "87299", "type": "CPT"}], "standard_charges": [{"minimum": 15.62, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 15.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY ELUTION", "code_information": [{"code": "86860", "type": "CPT"}, {"code": "702503942", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 28.94, "maximum": 203.43, "gross_charge": 106.04, "discounted_cash": 132.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 69.98, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 69.98, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 69.98, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 79.53, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 79.53, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 203.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 97.55, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 158.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 38.17, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 79.53, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY ID", "code_information": [{"code": "86870", "type": "CPT"}, {"code": "702503900", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 28.94, "maximum": 428.1, "gross_charge": 218.69, "discounted_cash": 273.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 144.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 144.33, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 144.33, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 164.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 164.01, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 428.1, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 201.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 359.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 331.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 359.28, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 78.72, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 164.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY IDENTIFICATION", "code_information": [{"code": "86870", "type": "CPT"}, {"code": "702503505", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 28.94, "maximum": 430.22, "gross_charge": 467.64, "discounted_cash": 584.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 308.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 308.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 308.64, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 350.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 350.73, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 428.1, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 430.22, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 359.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 331.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 359.28, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 168.35, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 350.73, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY SARS-COV-2 TITER(S)", "code_information": [{"code": "224U", "type": "CPT"}], "standard_charges": [{"minimum": 28.94, "maximum": 64.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 49.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY SCREEN", "code_information": [{"code": "86885", "type": "CPT"}, {"code": "702503510", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 28.94, "maximum": 203.43, "gross_charge": 104.7, "discounted_cash": 130.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 69.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 69.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 69.1, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 78.52, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 78.52, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 203.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 96.32, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 158.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 37.69, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 78.52, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY SCREEN - CHRG ONLY", "code_information": [{"code": "86850", "type": "CPT"}, {"code": "702503941", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 28.94, "maximum": 96.32, "gross_charge": 104.7, "discounted_cash": 130.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 69.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 69.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 69.1, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 78.52, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 78.52, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 96.32, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 53.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 53.36, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 37.69, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 78.52, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY SCREEN*", "code_information": [{"code": "86850", "type": "CPT"}, {"code": "702503511", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 28.94, "maximum": 96.32, "gross_charge": 104.7, "discounted_cash": 130.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 69.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 69.1, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 69.1, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 78.52, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 78.52, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 96.32, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 53.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 53.36, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 37.69, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 78.52, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY TEST PUB HLTH PATH", "code_information": [{"code": "D0605", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.94, "maximum": 61.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 61.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY TITER", "code_information": [{"code": "86886", "type": "CPT"}, {"code": "702503515", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 28.94, "maximum": 203.43, "gross_charge": 178.93, "discounted_cash": 223.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 118.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 118.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 118.09, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 134.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 134.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 203.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 164.61, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 158.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 64.41, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 134.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTICOAG CLINIC PER SESSION", "code_information": [{"code": "S9401", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTICOAG MGMT PT WARFARIN", "code_information": [{"code": "93793", "type": "CPT"}], "standard_charges": [{"minimum": 17.56, "maximum": 17.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 17.56, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTICOAG THX RX AT DISCHRG", "code_information": [{"code": "4075F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTICONV THXPY FOR 6 MOS/>", "code_information": [{"code": "4230F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTICONVULSANTS (GUS)", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "LABGA6013", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 73.59, "maximum": 188.06, "gross_charge": 204.42, "discounted_cash": 255.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 188.06, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 73.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTID GLBLN RCVD W/IN 26WKS", "code_information": [{"code": "4178F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRES RXTHXPY NOT RXD", "code_information": [{"code": "4063F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT NOT SPECIFIED", "code_information": [{"code": "80338", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT RX", "code_information": [{"code": "4064F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS (GUS)", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "LABGA6014", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 73.59, "maximum": 188.06, "gross_charge": 204.42, "discounted_cash": 255.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 188.06, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 73.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 1 OR 2", "code_information": [{"code": "80332", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 3-5", "code_information": [{"code": "80333", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 6/MORE", "code_information": [{"code": "80334", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC DRUG ORAL NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8597", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC DRUG ORAL NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8597", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC DRUG ORAL NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8597", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC RECTAL/SUPP NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8498", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC RECTAL/SUPP NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8498", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC RECTAL/SUPP NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8498", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTIC (GUS)", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "LABGA6015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 73.59, "maximum": 188.06, "gross_charge": 204.42, "discounted_cash": 255.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 188.06, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 73.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 1-3", "code_information": [{"code": "80339", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 4-6", "code_information": [{"code": "80340", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 7/MORE", "code_information": [{"code": "80341", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN TEST PUB HLTH PATHOG", "code_information": [{"code": "D0604", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.84, "maximum": 61.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 25.84, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95144", "type": "CPT"}], "standard_charges": [{"minimum": 42.57, "maximum": 79.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 79.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95145", "type": "CPT"}], "standard_charges": [{"minimum": 42.57, "maximum": 79.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 79.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95146", "type": "CPT"}], "standard_charges": [{"minimum": 42.57, "maximum": 79.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 79.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95147", "type": "CPT"}], "standard_charges": [{"minimum": 65.67, "maximum": 117.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95148", "type": "CPT"}], "standard_charges": [{"minimum": 65.67, "maximum": 117.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95149", "type": "CPT"}], "standard_charges": [{"minimum": 65.67, "maximum": 117.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 71.09, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95165", "type": "CPT"}], "standard_charges": [{"minimum": 42.57, "maximum": 79.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 79.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95170", "type": "CPT"}], "standard_charges": [{"minimum": 42.57, "maximum": 79.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 79.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN TYPING EACH AG TESTED", "code_information": [{"code": "86902", "type": "CPT"}, {"code": "702503507", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.83, "maximum": 428.1, "gross_charge": 164.36, "discounted_cash": 205.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 108.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 108.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 108.47, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 9.83, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 123.27, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 123.27, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 428.1, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 151.21, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 359.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 331.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 359.28, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 59.16, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 123.27, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGLOBULIN TECHNIQUE", "code_information": [{"code": "86922", "type": "CPT"}, {"code": "702503257", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 41.5, "maximum": 203.43, "gross_charge": 115.3, "discounted_cash": 144.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 76.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 76.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 76.09, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 86.47, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 86.47, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 203.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 106.07, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 158.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 41.5, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 86.47, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGLOBULIN XMATCH - CHRG ONLY", "code_information": [{"code": "86922", "type": "CPT"}, {"code": "702503936", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 120.24, "maximum": 307.29, "gross_charge": 334.02, "discounted_cash": 417.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 220.45, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 220.45, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 220.45, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 153.25, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 250.51, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 250.51, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 203.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 307.29, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 158.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 171.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 120.24, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 250.51, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIHEMOPHILIC VIII/VWF COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7186", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.11, "maximum": 1.4, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIHEMOPHILIC VIII/VWF COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7186", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIHEMOPHILIC VIII/VWF COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7186", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIHIST/DECONG RX/RECOM", "code_information": [{"code": "4133F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIMICROBIAL PACKING STRIPS 1/2I", "code_information": [{"code": "771030612", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 8.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTINOMYCES ANTIBODY", "code_information": [{"code": "86602", "type": "CPT"}], "standard_charges": [{"minimum": 9.87, "maximum": 48.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 10.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 10.69, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIPSHYCHOTICS (-QUET) (GUS)", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "LABGA6029", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 73.59, "maximum": 188.06, "gross_charge": 204.42, "discounted_cash": 255.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 188.06, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 73.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIPSHYCHOTICS (QUET ONLY) (GUS)", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "LABGA6033", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 73.59, "maximum": 188.06, "gross_charge": 204.42, "discounted_cash": 255.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 188.06, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 73.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTIC RX", "code_information": [{"code": "4065F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS (GUS)", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "LABGA6016", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 73.59, "maximum": 188.06, "gross_charge": 204.42, "discounted_cash": 255.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 134.91, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 100.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 188.06, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 73.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 153.31, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 1-3", "code_information": [{"code": "80342", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 4-6", "code_information": [{"code": "80343", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 7/MORE", "code_information": [{"code": "80344", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTISPASTICITY BALL SPLINT LG, R", "code_information": [{"code": "771023477", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 337.2, "discounted_cash": 421.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTISPERM ANTIBODIES TEST", "code_information": [{"code": "S3655", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.01, "maximum": 48.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 48.01, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTISTREPTOLYSIN O SCREEN", "code_information": [{"code": "86063", "type": "CPT"}], "standard_charges": [{"minimum": 5.6, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 7.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ACTIVITY", "code_information": [{"code": "85300", "type": "CPT"}], "standard_charges": [{"minimum": 11.49, "maximum": 41.76, "estimated_discounted_cash": 29.63, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 41.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 41.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 41.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 41.76, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7197", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.26, "maximum": 4.26, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4.26, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 3.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7197", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7197", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7196", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.51, "maximum": 147.53, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 139.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 147.53, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7196", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7196", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHYMOCYTE GLOBULN RABBIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 488.25, "maximum": 1057.86, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 488.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.25, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 488.25, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1057.86, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 949.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 876.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 949.11, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHYMOCYTE GLOBULN RABBIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7511", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHYMOCYTE GLOBULN RABBIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7511", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT 1ST GD", "code_information": [{"code": "561T", "type": "CPT"}], "standard_charges": [{"minimum": 54.81, "maximum": 99.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 99.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 54.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT EA ADDL", "code_information": [{"code": "562T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTMC MDL 3D PRINT 1ST CMPNT", "code_information": [{"code": "559T", "type": "CPT"}], "standard_charges": [{"minimum": 54.81, "maximum": 99.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 99.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 54.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTMC MDL 3D PRINT EA ADDL", "code_information": [{"code": "560T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANULEX ANULAR REPAIAR", "code_information": [{"code": "771029954", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13239.17, "discounted_cash": 16548.96, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANY HYGIENIC ITEM, DEVICE", "code_information": [{"code": "A9286", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANZEMET-10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1260", "type": "HCPCS"}, {"code": "691460770", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.51, "maximum": 34.88, "gross_charge": 37.92, "discounted_cash": 47.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 17.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 17.82, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 17.82, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6.51, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 28.44, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 28.44, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 34.88, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 13.65, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 28.44, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AOR ANE 5.5-5.9 CM MAX DIAM", "code_information": [{"code": "G9598", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AOR ANE >=6.0 CM MAX DIAM", "code_information": [{"code": "G9599", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORIC ROOT INJECTION", "code_information": [{"code": "93567", "type": "CPT"}, {"code": "713550240", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 277.7, "maximum": 709.68, "gross_charge": 771.4, "discounted_cash": 964.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 509.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 509.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 509.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 578.55, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 578.55, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 709.68, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 277.7, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 578.55, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORITC PUNCH", "code_information": [{"code": "771013522", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 535.33, "discounted_cash": 669.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [{"code": "268", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39675.97, "maximum": 84854.93, "estimated_discounted_cash": 9081.24, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 41350.25, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70430.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 84854.93, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 84854.93, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76370.09, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 80694.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 42948.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 41350.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 39675.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 42948.21, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 53173.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [{"code": "269", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20709.73, "maximum": 54026.96, "estimated_discounted_cash": 160850.31, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 20709.73, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 44843.08, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 54026.96, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 54026.96, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 48624.68, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 48955.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 26800.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 20709.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 24758.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 26800.44, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 33181.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC ANEURYSM 5-5.4CM DIAM", "code_information": [{"code": "9002F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC ANEURYSM<5CM DIAM CT", "code_information": [{"code": "9001F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC ANRYSM 6/> CM DIAM", "code_information": [{"code": "9004F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC ANRYSM5.5-5.9CM DIAM", "code_information": [{"code": "9003F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC BALLOON INSERTION-ICU", "code_information": [{"code": "630113760", "type": "CDM"}, {"code": "739", "type": "RC"}], "standard_charges": [{"gross_charge": 1465.53, "discounted_cash": 1831.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC BODY AAA", "code_information": [{"code": "771034087", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 33491.42, "discounted_cash": 41864.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC CANNULA 14GA W/VENT", "code_information": [{"code": "771006696", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 236.04, "discounted_cash": 295.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC CANNULA 7MM", "code_information": [{"code": "771029939", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 424.46, "discounted_cash": 530.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC CANNULA 8MM", "code_information": [{"code": "771029940", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 451.03, "discounted_cash": 563.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33970", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33971", "type": "CPT"}], "standard_charges": [{"minimum": 6681.17, "maximum": 9255.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6681.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 9255.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 9255.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 7246.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC CONNECOTR", "code_information": [{"code": "771022800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2799.21, "discounted_cash": 3499.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC CONNECTION 5.5", "code_information": [{"code": "771022877", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2799.21, "discounted_cash": 3499.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC CONNECTOR", "code_information": [{"code": "771022687", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28982.33, "discounted_cash": 36227.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC CONNECTOR 6.0", "code_information": [{"code": "771022878", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2799.21, "discounted_cash": 3499.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC CUFF", "code_information": [{"code": "771026332", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13154.86, "discounted_cash": 16443.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC CUFF", "code_information": [{"code": "771033151", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 12528.18, "discounted_cash": 15660.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81410", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 630.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81411", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 1687.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1687.74, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1417.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1309.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1417.7, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC EXTENDER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771035288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 18038.57, "maximum": 46098.58, "gross_charge": 50107.16, "discounted_cash": 62633.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 18539.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 18539.64, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 18539.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 37580.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 37580.37, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 46098.58, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 18038.57, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 37580.37, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC HEMIARCH GRAFT", "code_information": [{"code": "33866", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC PUCH 5.2", "code_information": [{"code": "771021749", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 269.62, "discounted_cash": 337.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC PUNCH 3.6 65-9012", "code_information": [{"code": "771025299", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 330.19, "discounted_cash": 412.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC PUNCH 4.0", "code_information": [{"code": "771021746", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 330.74, "discounted_cash": 413.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC PUNCH 4.4", "code_information": [{"code": "771026753", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 306.84, "discounted_cash": 383.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC PUNCH 4.8", "code_information": [{"code": "771025132", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 351.26, "discounted_cash": 439.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC SUSPENSION", "code_information": [{"code": "33800", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC VALVED GRAFT", "code_information": [{"code": "771021553", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 42003.72, "discounted_cash": 52504.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTIC VALVED GRAFT", "code_information": [{"code": "771021554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25752.86, "discounted_cash": 32191.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AORTOGRAPHY ABDOMINAL TC", "code_information": [{"code": "75625", "type": "CPT"}, {"code": "713550090", "type": "CDM"}, {"code": "321", "type": "RC"}], "standard_charges": [{"minimum": 250.5, "maximum": 11038.55, "gross_charge": 11998.43, "discounted_cash": 14998.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 7918.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 7918.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 7918.96, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 8998.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8998.82, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6074.02, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 11038.55, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4319.43, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 8998.82, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APARTURE DRAPE 16 X16", "code_information": [{"code": "771012629", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 50.69, "discounted_cash": 63.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APC GENE DUP/DELET VARIANTS", "code_information": [{"code": "81203", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 250.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 250.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APC GENE FULL SEQUENCE", "code_information": [{"code": "81201", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 975.0, "estimated_discounted_cash": 1950.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 975.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 756.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APC GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81202", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 350.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APC MRNA SEQ ALYS", "code_information": [{"code": "157U", "type": "CPT"}], "standard_charges": [{"minimum": 51.17, "maximum": 297.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 51.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 51.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 51.17, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 51.17, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 297.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 274.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 297.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APC PROBE (ERBE)", "code_information": [{"code": "771019811", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1418.03, "discounted_cash": 1772.54, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APC SIDE FIRE PROBE", "code_information": [{"code": "771021414", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1441.79, "discounted_cash": 1802.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APC SIDEFIRE PROBE", "code_information": [{"code": "771029600", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1419.44, "discounted_cash": 1774.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APDG LOOP /10/25", "code_information": [{"code": "771011935", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 947.32, "discounted_cash": 1184.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APERFILL II CANN TIBIAL 9X30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771035432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 828.06, "maximum": 2116.15, "gross_charge": 2300.17, "discounted_cash": 2875.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 851.06, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 851.06, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 851.06, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1725.12, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1725.12, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2116.15, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 828.06, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1725.12, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX 2.75X8", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 419.34, "maximum": 1071.65, "gross_charge": 1164.84, "discounted_cash": 1456.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1071.65, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 419.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX 3.25X12", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 281.23, "maximum": 718.72, "gross_charge": 781.22, "discounted_cash": 976.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 289.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 289.05, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 289.05, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 585.91, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 585.91, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 718.72, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 281.23, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 585.91, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX 3.25X8", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 419.34, "maximum": 1071.65, "gross_charge": 1164.84, "discounted_cash": 1456.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1071.65, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 419.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX 3.5X8", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 419.34, "maximum": 1071.65, "gross_charge": 1164.84, "discounted_cash": 1456.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1071.65, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 419.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX 3.75X15", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 419.34, "maximum": 1071.65, "gross_charge": 1164.84, "discounted_cash": 1456.05, 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944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX RX 4.0X12", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 453.22, "maximum": 1158.25, "gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX RX 4.0X15", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771030796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 453.22, "maximum": 1158.25, "gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX RX 4.0X20", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771030806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 419.34, "maximum": 1071.65, "gross_charge": 1164.84, "discounted_cash": 1456.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 430.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1071.65, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 419.34, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 873.63, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX RX 4.0X30", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 453.22, "maximum": 1158.25, "gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX RX 4.0X40", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771039647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 453.22, "maximum": 1158.25, "gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX RX 4.5X15", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771030797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 453.22, "maximum": 1158.25, "gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX RX 4.5X20", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771030807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 453.22, "maximum": 1158.25, "gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX RX 5.0X15", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771030798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 453.22, "maximum": 1158.25, "gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEX RX 5.0X20", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "771030808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 453.22, "maximum": 1158.25, "gross_charge": 1258.97, "discounted_cash": 1573.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 465.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1158.25, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 453.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 944.22, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC FINAL", "code_information": [{"code": "D3353", "type": "HCPCS"}], "standard_charges": [{"minimum": 429.95, "maximum": 1660.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 429.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 595.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 595.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 466.34, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 438.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC INITIAL", "code_information": [{"code": "D3351", "type": "HCPCS"}], "standard_charges": [{"minimum": 309.0, "maximum": 1660.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 429.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 595.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 595.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 466.34, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 309.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC INTERIM", "code_information": [{"code": "D3352", "type": "HCPCS"}], "standard_charges": [{"minimum": 221.0, "maximum": 1660.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 429.95, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 595.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 595.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 466.34, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHAKIA PROSTH SERVICE TEMP", "code_information": [{"code": "92358", "type": "CPT"}], "standard_charges": [{"minimum": 54.81, "maximum": 155.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 155.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 101.99, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 54.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS 250ML FFP - CHRG ONLY", "code_information": [{"code": "P9017", "type": "HCPCS"}, {"code": "702503976", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 77.77, "maximum": 3404.65, "gross_charge": 522.27, "discounted_cash": 652.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 344.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 344.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 344.69, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2457.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2665.81, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 391.7, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 391.7, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 119.94, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 480.48, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 84.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 77.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 84.19, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 188.01, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 391.7, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS AB FFP -CHRG ONLY-", "code_information": [{"code": "P9017", "type": "HCPCS"}, {"code": "702503998", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 77.77, "maximum": 3404.65, "gross_charge": 804.62, "discounted_cash": 1005.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 531.04, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 531.04, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 531.04, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2457.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2665.81, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 603.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 603.46, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 119.94, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 740.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 84.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 77.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 84.19, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 289.66, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 603.46, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS CRYO - 1", "code_information": [{"code": "702503522", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 1.06, "discounted_cash": 1.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS CRYO - 2", "code_information": [{"code": "702503612", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 1.06, "discounted_cash": 1.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS CRYO - 3", "code_information": [{"code": "702503622", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 1.06, "discounted_cash": 1.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS CRYO - 4", "code_information": [{"code": "702503608", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 1.06, "discounted_cash": 1.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS CRYO -1", "code_information": [{"code": "702503395", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 2.63, "discounted_cash": 3.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS FF PLASMA - 1", "code_information": [{"code": "702503396", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 2.63, "discounted_cash": 3.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS FF PLASMA - 2", "code_information": [{"code": "702503383", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 1.06, "discounted_cash": 1.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS FF PLASMA - 3", "code_information": [{"code": "702503384", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 1.06, "discounted_cash": 1.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS FF PLASMA - 4", "code_information": [{"code": "702503385", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 1.06, "discounted_cash": 1.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS IMMUNOADS SLCTV", "code_information": [{"code": "36516", "type": "CPT"}], "standard_charges": [{"minimum": 1805.57, "maximum": 10731.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 1805.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7746.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10731.37, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10731.37, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8402.57, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 7495.88, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 4679.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1805.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4322.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 4679.46, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLASMA", "code_information": [{"code": "36514", "type": "CPT"}], "standard_charges": [{"minimum": 790.03, "maximum": 10731.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 790.03, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7746.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10731.37, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10731.37, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8402.57, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2485.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1637.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 790.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1512.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1637.29, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELET-2", "code_information": [{"code": "702503392", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 1.06, "discounted_cash": 1.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS", "code_information": [{"code": "36513", "type": "CPT"}], "standard_charges": [{"minimum": 212.83, "maximum": 3404.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 212.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2457.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2665.81, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 703.14, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 436.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 212.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 403.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 436.64, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS - 1", "code_information": [{"code": "702503394", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 1.06, "discounted_cash": 1.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APHERESIS RBC", "code_information": [{"code": "36512", "type": "CPT"}], "standard_charges": [{"minimum": 790.03, "maximum": 3404.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 790.03, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2457.8, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3404.65, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2665.81, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2485.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1637.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 790.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1512.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1637.29, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS WBC", "code_information": [{"code": "36511", "type": "CPT"}], "standard_charges": [{"minimum": 790.03, "maximum": 10731.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 790.03, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7746.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10731.37, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10731.37, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8402.57, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2485.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1637.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 790.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1512.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1637.29, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHLX TO VAX BEF ENC", "code_information": [{"code": "M1311", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APICALLY POSITIONED FLAP", "code_information": [{"code": "D4245", "type": "HCPCS"}], "standard_charges": [{"minimum": 690.0, "maximum": 1479.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1366.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1479.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APICOECTOMY - ANTERIOR", "code_information": [{"code": "D3410", "type": "HCPCS"}], "standard_charges": [{"minimum": 567.35, "maximum": 1660.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 567.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 785.92, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 785.92, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 615.37, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 621.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1534.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1660.61, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APIS, PER SQUARE CENTIMETER", "code_information": [{"code": "A2010", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APLIGRAF PER SQ CM", "code_information": [{"code": "Q4101", "type": "HCPCS"}, {"code": "771027114", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 34.91, "maximum": 112.43, "gross_charge": 122.21, "discounted_cash": 152.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 57.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 57.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 57.43, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 91.65, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 91.65, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 34.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 112.43, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 43.99, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 91.65, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APLIGRAF, PER 1 SQ CM", "code_information": [{"code": "Q4101", "type": "HCPCS"}, {"code": "771045005", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 34.91, "maximum": 112.43, "gross_charge": 122.21, "discounted_cash": 152.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 57.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 57.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 57.43, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 91.65, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 91.65, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 34.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 112.43, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 43.99, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 91.65, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APLY SKIN ADDL 25 SQ CM FEET", "code_information": [{"code": "656030415", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1674.89, "discounted_cash": 2093.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APLY SKIN SUB 1ST 100 SQ CM FEET MEDICAR", "code_information": [{"code": "656030425", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1674.89, "discounted_cash": 2093.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APLY SKIN SUB 1ST 100 SQ CM LEGS MEDICAR", "code_information": [{"code": "656030420", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1674.89, "discounted_cash": 2093.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APLY SKIN SUB 1ST 25 SQ CM FEET MEDICARE", "code_information": [{"code": "656030405", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1674.89, "discounted_cash": 2093.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APLY SKIN SUB 1ST 25 SQ CM LEGS MEDICARE", "code_information": [{"code": "656030400", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1674.89, "discounted_cash": 2093.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APLY SKIN SUB ADL 25 SQ CM LEGS MEDICARE", "code_information": [{"code": "656030410", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1674.89, "discounted_cash": 2093.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APLY SKIN SUB EA ADL 100 SQ CM FEET MC", "code_information": [{"code": "656030435", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1674.89, "discounted_cash": 2093.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APLY SKIN SUB EA ADL 100 SQ CM LEGS MC", "code_information": [{"code": "656030430", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1674.89, "discounted_cash": 2093.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APLY SKIN SUB EA ADL 100SQCM FEET", "code_information": [{"code": "656030395", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2241.16, "discounted_cash": 2801.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APLY SKIN SUB-EA ADL 100SQCM LEGS", "code_information": [{"code": "656030390", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2241.16, "discounted_cash": 2801.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APNEA MONITOR", "code_information": [{"code": "630113765", "type": "CDM"}, {"code": "222", "type": "RC"}], "standard_charges": [{"gross_charge": 320.34, "discounted_cash": 400.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APOL1 RISK VARIANTS", "code_information": [{"code": "355U", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 143.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 132.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APOMORPHINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.69, "maximum": 37.01, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 30.69, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 37.01, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APOMORPHINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0364", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APOMORPHINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0364", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+HUBBRD TNK EA 15", "code_information": [{"code": "97036", "type": "CPT"}], "standard_charges": [{"minimum": 48.5, "maximum": 97.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 48.5, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX 1ST", "code_information": [{"code": "20696", "type": "CPT"}], "standard_charges": [{"minimum": 8089.31, "maximum": 30185.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 30185.68, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16968.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX XCH", "code_information": [{"code": "20697", "type": "CPT"}], "standard_charges": [{"minimum": 1476.67, "maximum": 11205.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2603.26, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1476.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP OF HYDROXYAPATITE", "code_information": [{"code": "D2991", "type": "HCPCS"}], "standard_charges": [{"minimum": 4866.23, "maximum": 6740.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4866.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6740.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6740.91, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5278.07, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP OF SHORT ARM SPLINT-STATIC", "code_information": [{"code": "686249000", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 259.22, "discounted_cash": 324.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APP OF SHORT ARM SPLINT-STATIC", "code_information": [{"code": "29125", "type": "CPT"}, {"code": "686139000", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 93.31, "maximum": 919.47, "gross_charge": 259.22, "discounted_cash": 324.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 171.08, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 171.08, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 171.08, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 194.41, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 194.41, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 206.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 238.48, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 93.31, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 194.41, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "99188", "type": "CPT"}], "standard_charges": [{"minimum": 103.12, "maximum": 103.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 103.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 103.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 103.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 103.12, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPEL-BERCI CYSTIC DUCT INTRODUCER SET", "code_information": [{"code": "771039322", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 637.07, "discounted_cash": 796.34, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44950", "type": "CPT"}], "standard_charges": [{"minimum": 5757.32, "maximum": 12254.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7557.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10469.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10469.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8197.35, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 12254.3, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 6232.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 5757.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 6232.15, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44960", "type": "CPT"}], "standard_charges": [{"minimum": 7557.74, "maximum": 10469.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7557.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10469.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10469.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8197.35, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY ADD-ON", "code_information": [{"code": "44955", "type": "CPT"}], "standard_charges": [{"minimum": 7557.74, "maximum": 10469.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7557.74, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 10469.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 10469.28, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8197.35, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDICO-VESICOSTOMY", "code_information": [{"code": "50845", "type": "CPT"}], "standard_charges": [{"minimum": 9960.26, "maximum": 13797.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9960.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13797.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13797.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10803.21, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH CC", "code_information": [{"code": "398", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6232.81, "maximum": 19674.41, "estimated_discounted_cash": 55153.07, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 6232.81, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 16330.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 19674.41, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 19674.41, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17707.12, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 17815.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 9747.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 6232.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9004.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 9747.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 12067.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH MCC", "code_information": [{"code": "397", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7960.54, "maximum": 29208.05, "estimated_discounted_cash": 51154.7, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 7960.54, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24243.06, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 29208.05, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 29208.05, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26287.47, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 26447.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 15960.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 7960.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 14744.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 15960.33, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 19760.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "399", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5020.47, "maximum": 14471.41, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 5020.47, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12011.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14471.41, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14471.41, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13024.38, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 13103.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7238.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5020.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6687.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7238.76, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 8962.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL DESENSITIZING RESIN", "code_information": [{"code": "D9911", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.0, "maximum": 62.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 62.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL HALO CRANIAL 6+PINS", "code_information": [{"code": "20664", "type": "CPT"}], "standard_charges": [{"minimum": 8089.31, "maximum": 11205.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL MLTPLN UNI EXT FIXJ SYS", "code_information": [{"code": "20692", "type": "CPT"}], "standard_charges": [{"minimum": 7562.41, "maximum": 21317.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 7562.41, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21317.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 7562.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11872.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+LLLT PO PAIN", "code_information": [{"code": "97037", "type": "CPT"}], "standard_charges": [{"minimum": 36.22, "maximum": 97.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 39.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 36.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 39.21, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL MULTLAY COMPRS ARM/HAND", "code_information": [{"code": "29584", "type": "CPT"}], "standard_charges": [{"minimum": 145.59, "maximum": 919.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL SLVR DIAMN FLUORIDE 38%", "code_information": [{"code": "792T", "type": "CPT"}], "standard_charges": [{"minimum": 103.12, "maximum": 103.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 103.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 103.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 103.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 103.12, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL UNIPLN UNI EXT FIXJ SYS", "code_information": [{"code": "20690", "type": "CPT"}], "standard_charges": [{"minimum": 4423.22, "maximum": 11587.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 4423.22, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 11587.76, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 4423.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 6591.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 7135.02, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL. OF FINGER SPLINT-DYNAMIC", "code_information": [{"code": "686249002", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 259.22, "discounted_cash": 324.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPL. OF FINGER SPLINT-DYNAMIC", "code_information": [{"code": "29131", "type": "CPT"}, {"code": "686029262", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 54.81, "maximum": 919.47, "gross_charge": 274.77, "discounted_cash": 343.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 99.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 252.78, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 54.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 98.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL. OF FINGER SPLINT-DYNAMIC", "code_information": [{"code": "29131", "type": "CPT"}, {"code": "686139002", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 54.81, "maximum": 919.47, "gross_charge": 275.37, "discounted_cash": 344.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 181.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 181.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 181.74, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 206.52, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 206.52, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 99.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 253.34, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 54.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 99.13, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 206.52, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL. OF FINGER SPLINT-STATIC", "code_information": [{"code": "686249004", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 259.22, "discounted_cash": 324.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPL. 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OF LONG ARM SPLINT", "code_information": [{"code": "686249006", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 259.22, "discounted_cash": 324.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPL. OF LONG ARM SPLINT", "code_information": [{"code": "29105", "type": "CPT"}, {"code": "686139006", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 93.31, "maximum": 919.47, "gross_charge": 259.22, "discounted_cash": 324.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 171.08, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 171.08, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 171.08, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 194.41, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 194.41, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 238.48, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 93.31, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 194.41, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL. OF SHORT ARM SPLINT-DYNAMIC", "code_information": [{"code": "29126", "type": "CPT"}, {"code": "686029260", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 98.91, "maximum": 919.47, "gross_charge": 274.77, "discounted_cash": 343.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 206.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 252.78, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 98.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL. OF SHORT ARM SPLINT-DYNAMIC", "code_information": [{"code": "29126", "type": "CPT"}, {"code": "686139008", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 99.13, "maximum": 919.47, "gross_charge": 275.37, "discounted_cash": 344.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 181.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 181.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 181.74, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 206.52, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 206.52, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 206.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 253.34, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 99.13, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 206.52, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL. OF SHORT ARM SPLINT-STATIC", "code_information": [{"code": "29125", "type": "CPT"}, {"code": "686029270", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 98.91, "maximum": 919.47, "gross_charge": 274.77, "discounted_cash": 343.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 206.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 252.78, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 98.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLIANCE REMOVAL", "code_information": [{"code": "D7997", "type": "HCPCS"}], "standard_charges": [{"minimum": 4956.15, "maximum": 6865.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4956.15, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6865.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5375.59, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO CRANIAL", "code_information": [{"code": "20661", "type": "CPT"}], "standard_charges": [{"minimum": 352.6, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO FEMORAL", "code_information": [{"code": "20663", "type": "CPT"}], "standard_charges": [{"minimum": 2993.75, "maximum": 7263.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5243.39, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 7263.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 7263.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5687.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5242.85, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3240.66, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO PELVIC", "code_information": [{"code": "20662", "type": "CPT"}], "standard_charges": [{"minimum": 1476.67, "maximum": 7263.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5243.39, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 7263.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 7263.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5687.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2603.26, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1476.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION LONG LEG SPLINT", "code_information": [{"code": "29505", "type": "CPT"}], "standard_charges": [{"minimum": 145.59, "maximum": 919.47, "estimated_discounted_cash": 389.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION LOWER LEG SPLINT", "code_information": [{"code": "29515", "type": "CPT"}], "standard_charges": [{"minimum": 145.59, "maximum": 919.47, "estimated_discounted_cash": 267.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29000", "type": "CPT"}], "standard_charges": [{"minimum": 128.01, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29010", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29015", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29035", "type": "CPT"}], "standard_charges": [{"minimum": 128.01, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29040", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29044", "type": "CPT"}], "standard_charges": [{"minimum": 76.08, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 76.08, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 76.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29046", "type": "CPT"}], "standard_charges": [{"minimum": 128.01, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FIGURE EIGHT", "code_information": [{"code": "29049", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FOREARM CAST", "code_information": [{"code": "29075", "type": "CPT"}], "standard_charges": [{"minimum": 52.87, "maximum": 488.43, "estimated_discounted_cash": 302.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 52.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 52.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CAST", "code_information": [{"code": "29305", "type": "CPT"}], "standard_charges": [{"minimum": 128.01, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CASTS", "code_information": [{"code": "29325", "type": "CPT"}], "standard_charges": [{"minimum": 128.01, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LEG CAST", "code_information": [{"code": "29450", "type": "CPT"}], "standard_charges": [{"minimum": 61.59, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 61.59, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 61.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG ARM CAST", "code_information": [{"code": "29065", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "estimated_discounted_cash": 303.23, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG ARM SPLINT", "code_information": [{"code": "29105", "type": "CPT"}, {"code": "686029258", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 98.91, "maximum": 919.47, "gross_charge": 274.77, "discounted_cash": 343.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 181.34, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 252.78, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 98.91, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 206.07, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29345", "type": "CPT"}], "standard_charges": [{"minimum": 73.5, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29355", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "estimated_discounted_cash": 294.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29365", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF PASTE BOOT", "code_information": [{"code": "29580", "type": "CPT"}], "standard_charges": [{"minimum": 145.59, "maximum": 919.47, "estimated_discounted_cash": 718.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29055", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29058", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION ON-BODY INJECTOR", "code_information": [{"code": "96377", "type": "CPT"}, {"code": "691461702", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 20.23, "maximum": 79.21, "gross_charge": 56.2, "discounted_cash": 70.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 37.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 37.09, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 37.09, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 42.15, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 42.15, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 79.21, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 51.7, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 42.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 20.23, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 42.15, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORA PREP ORANGE", "code_information": [{"code": "771027723", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 84.29, "discounted_cash": 105.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLICATOR ENDO SURGIFLO", "code_information": [{"code": "771035043", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 720.81, "discounted_cash": 901.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLICATOR EVICEL 35CM", "code_information": [{"code": "771033762", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 389.2, "discounted_cash": 486.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLICATOR EVICEL 45CM", "code_information": [{"code": "771033764", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 251.5, "discounted_cash": 314.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLIED GEL PORT", "code_information": [{"code": "771026259", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2607.9, "discounted_cash": 3259.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLIED SLECCVE AND SEAL", "code_information": [{"code": "771026258", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 819.16, "discounted_cash": 1023.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLIED SLEEVE & SEAL 11MM", "code_information": [{"code": "771026261", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 901.07, "discounted_cash": 1126.34, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLY FINGER CAST", "code_information": [{"code": "29086", "type": "CPT"}], "standard_charges": [{"minimum": 145.59, "maximum": 1579.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1140.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1579.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1579.61, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1236.82, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY HAND/WRIST CAST", "code_information": [{"code": "29085", "type": "CPT"}], "standard_charges": [{"minimum": 145.59, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY INTERSTIT RADIAT COMPL", "code_information": [{"code": "77778", "type": "CPT"}], "standard_charges": [{"minimum": 640.17, "maximum": 22876.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 16514.19, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 22876.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 22876.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17911.8, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1366.26, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 692.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 640.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 692.97, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIATE SIMPLE", "code_information": [{"code": "77761", "type": "CPT"}, {"code": "700040528", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 533.74, "maximum": 22876.12, "gross_charge": 1811.19, "discounted_cash": 2263.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1195.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1195.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1195.38, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 16514.19, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 22876.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 22876.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17911.8, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1358.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1358.39, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1121.74, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1666.29, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 577.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 533.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 577.76, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 652.02, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1358.39, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY LONG LEG CAST BRACE", "code_information": [{"code": "29358", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY MULTLAY COMPRS LWR LEG", "code_information": [{"code": "29581", "type": "CPT"}], "standard_charges": [{"minimum": 145.59, "maximum": 919.47, "estimated_discounted_cash": 424.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 663.76, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 919.47, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 719.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 157.59, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 157.39, "count": "1 through 10", "median_amount": 157.39, "methodology": "percent of total billed charges", "10th_percentile": 157.39, "90th_percentile": 157.39}], "billing_class": "facility"}]}, {"description": "APPLY R&L PULM ART BANDS", "code_information": [{"code": "33620", "type": "CPT"}], "standard_charges": [{"minimum": 6365.83, "maximum": 8818.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 6365.83, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8818.21, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8818.21, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6904.58, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY REM FIXATION DEVICE", "code_information": [{"code": "20660", "type": "CPT"}], "standard_charges": [{"minimum": 1476.67, "maximum": 7263.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5243.39, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 7263.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 7263.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 5687.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2603.26, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1476.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29425", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "estimated_discounted_cash": 312.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29435", "type": "CPT"}], "standard_charges": [{"minimum": 245.05, "maximum": 488.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 352.6, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 488.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 382.44, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 265.26, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY SKIN ADDL 25 SQ CM FEET", "code_information": [{"code": "656030375", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2241.16, "discounted_cash": 2801.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLY SKIN SUB 1ST 100 SQ CM LEGS", "code_information": [{"code": "656030380", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4759.26, "discounted_cash": 5949.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLY SKIN SUB 1ST 25 SQ CM FEET", "code_information": [{"code": "656030365", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2241.16, "discounted_cash": 2801.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLY SKIN SUB 1ST 25 SQ CM LEGS", "code_information": [{"code": "656030360", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2605.1, "discounted_cash": 3256.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLY SKIN SUB ADDL 25 SQ CM LEGS", "code_information": [{"code": "656030370", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2241.16, "discounted_cash": 2801.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLY SRS HEADFRAME ADD-ON", "code_information": [{"code": "61800", "type": "CPT"}], "standard_charges": [{"minimum": 230.4, "maximum": 15348.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11080.16, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 15348.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 15348.68, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12017.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 230.4, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY SURF LDR RADIONUCLIDE", "code_information": [{"code": "77789", "type": "CPT"}], "standard_charges": [{"minimum": 101.04, "maximum": 22876.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 16514.19, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 22876.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 22876.12, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 17911.8, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 228.5, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 109.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 101.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 109.37, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPRO RAD DS DVCS TECHS DOCD", "code_information": [{"code": "6040F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROACH ST MICROWIRE 014 300CM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "771048832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 554.2, "maximum": 1416.3, "gross_charge": 1539.46, "discounted_cash": 1924.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 569.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 569.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 569.6, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1154.59, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1154.59, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1416.3, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 554.2, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1154.59, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP ACE/ARB TSTNG DONE", "code_information": [{"code": "4188F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP ANTICONVULS TSTNG", "code_information": [{"code": "4191F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP DIGOXIN TSTNG DONE", "code_information": [{"code": "4189F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP DIURETIC TSTNG DONE", "code_information": [{"code": "4190F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP ORAL REHYD RECOMMD", "code_information": [{"code": "4056F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROPOS MTHD OFFLOADING RXD", "code_information": [{"code": "4269F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APRAXIA BOOKLET", "code_information": [{"code": "771002570", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 44.65, "discounted_cash": 55.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APROTONIN, 10,000 KIU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APROTONIN, 10,000 KIU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0365", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APROTONIN, 10,000 KIU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0365", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQAPRN-4 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86053", "type": "CPT"}], "standard_charges": [{"minimum": 28.94, "maximum": 47.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 39.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 36.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 39.62, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQMBF PET REST & RX STRESS", "code_information": [{"code": "78434", "type": "CPT"}], "standard_charges": [{"minimum": 4399.02, "maximum": 6093.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 4399.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 6093.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 6093.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 4771.32, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQMBF SPECT XERS/STRS & REST", "code_information": [{"code": "742T", "type": "CPT"}], "standard_charges": [{"minimum": 1710.4, "maximum": 2369.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1710.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 2369.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 2369.32, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1855.16, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUACEL 4X4 TAKE HOME", "code_information": [{"code": "A6196", "type": "HCPCS"}, {"code": "771030739", "type": "CDM"}, {"code": "623", "type": "RC"}], "standard_charges": [{"minimum": 9.97, "maximum": 43.93, "gross_charge": 47.76, "discounted_cash": 59.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 31.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 31.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 31.52, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 35.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 35.82, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 43.93, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 10.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 10.79, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 17.19, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 35.82, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUACEL AG 4X4.7 TAKE HOME", "code_information": [{"code": "A6197", "type": "HCPCS"}, {"code": "771030740", "type": "CDM"}, {"code": "623", "type": "RC"}], "standard_charges": [{"minimum": 22.29, "maximum": 109.59, "gross_charge": 119.13, "discounted_cash": 148.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 78.62, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 78.62, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 78.62, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 89.34, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 89.34, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 33.66, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 109.59, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 42.88, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 89.34, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUACEL AG EXTRA 2X2", "code_information": [{"code": "A6196", "type": "HCPCS"}, {"code": "771043475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 4.54, "maximum": 15.06, "gross_charge": 12.62, "discounted_cash": 15.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8.32, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8.32, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9.46, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 11.61, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 10.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 10.79, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9.46, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUACEL AG EXTRA 4X5", "code_information": [{"code": "A6197", "type": "HCPCS"}, {"code": "771043473", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 10.11, "maximum": 33.66, "gross_charge": 28.09, "discounted_cash": 35.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 18.53, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 18.53, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 18.53, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 21.06, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 21.06, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 33.66, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 25.84, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 10.11, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 21.06, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUACEL AG SILVER 3/4X18", "code_information": [{"code": "771036058", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.38, "discounted_cash": 1.73, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUACEL AG SURGICAL DRESSING 3.5X6", "code_information": [{"code": "771048561", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 442.93, "discounted_cash": 553.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUACEL EXTRA HYDROFIBER 2X2", "code_information": [{"code": "A6196", "type": "HCPCS"}, {"code": "771043474", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 4.54, "maximum": 15.06, "gross_charge": 12.62, "discounted_cash": 15.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8.32, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8.32, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 9.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 9.46, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 11.61, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 10.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 9.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 10.79, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 4.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 9.46, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUACEL EXTRA HYDROFIBER 4X5", "code_information": [{"code": "A6197", "type": "HCPCS"}, {"code": "771043476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 10.11, "maximum": 33.66, "gross_charge": 28.09, "discounted_cash": 35.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 18.53, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 18.53, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 18.53, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 21.06, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 21.06, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 33.66, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 25.84, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 10.11, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 21.06, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUACEL SURGICAL DRESSING 10\"", "code_information": [{"code": "771040601", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 411.67, "discounted_cash": 514.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUACEL SURGICAL DRESSING 14\"", "code_information": [{"code": "771040603", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 456.64, "discounted_cash": 570.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUAMANTYS 6.0", "code_information": [{"code": "771030199", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2464.58, "discounted_cash": 3080.73, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUAMANTYS EVS", "code_information": [{"code": "771030133", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3605.96, "discounted_cash": 4507.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUAMANTYS SEALER", "code_information": [{"code": "771029135", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2630.4, "discounted_cash": 3288.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB CBA EACH", "code_information": [{"code": "86052", "type": "CPT"}], "standard_charges": [{"minimum": 11.69, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 15.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB ELISA", "code_information": [{"code": "86051", "type": "CPT"}], "standard_charges": [{"minimum": 11.18, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 28.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY (15 MIN)", "code_information": [{"code": "682248000", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 157.34, "discounted_cash": 196.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY (15 MIN)", "code_information": [{"code": "686249010", "type": "CDM"}, {"code": "431", "type": "RC"}], "standard_charges": [{"gross_charge": 157.34, "discounted_cash": 196.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY (15 MIN)", "code_information": [{"code": "97113", "type": "CPT"}, {"code": "682028000", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 51.51, "maximum": 143.84, "gross_charge": 156.35, "discounted_cash": 195.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 103.19, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 103.19, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 103.19, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 117.26, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 117.26, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 51.51, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 143.84, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 56.28, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 117.26, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY (15 MIN)", "code_information": [{"code": "97113", "type": "CPT"}, {"code": "686139010", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 51.51, "maximum": 135.71, "gross_charge": 147.52, "discounted_cash": 184.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 97.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 97.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 97.36, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 110.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 110.64, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 51.51, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 135.71, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 53.1, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 110.64, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY (15MIN)", "code_information": [{"code": "97113", "type": "CPT"}, {"code": "682138000", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 51.51, "maximum": 135.71, "gross_charge": 147.52, "discounted_cash": 184.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 97.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 97.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 97.36, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 110.64, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 110.64, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 51.51, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 135.71, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 53.1, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 110.64, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY (15MIN)", "code_information": [{"code": "97113", "type": "CPT"}, {"code": "686029000", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 51.51, "maximum": 144.75, "gross_charge": 157.34, "discounted_cash": 196.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 103.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 103.84, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 103.84, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 118.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 118.0, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 51.51, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 144.75, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 56.64, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 118.0, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY-EA 15 MIN", "code_information": [{"code": "97113", "type": "CPT"}, {"code": "689029750", "type": "CDM"}, {"code": "941", "type": "RC"}], "standard_charges": [{"minimum": 28.96, "maximum": 97.75, "gross_charge": 80.47, "discounted_cash": 100.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 53.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 53.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 53.11, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 70.56, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 97.75, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 60.35, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 60.35, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 51.51, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 74.03, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 28.96, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 60.35, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/GRAFT", "code_information": [{"code": "66180", "type": "CPT"}], "standard_charges": [{"minimum": 3075.13, "maximum": 11026.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 3075.13, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7959.96, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11026.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11026.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8633.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6585.63, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5153.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3075.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4760.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5153.42, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/O GRAFT", "code_information": [{"code": "66179", "type": "CPT"}], "standard_charges": [{"minimum": 4760.78, "maximum": 11026.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 7959.96, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11026.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11026.46, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8633.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8465.66, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5153.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4760.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5153.42, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AR FULL SEQUENCE ANALYSIS", "code_information": [{"code": "230U", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 316.42, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 316.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 292.31, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 316.42, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AR GENE CHARAC ALLELES", "code_information": [{"code": "81204", "type": "CPT"}], "standard_charges": [{"minimum": 77.63, "maximum": 143.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 77.63, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 132.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AR GENE FULL GENE SEQUENCE", "code_information": [{"code": "81173", "type": "CPT"}], "standard_charges": [{"minimum": 145.04, "maximum": 376.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 376.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 316.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 292.31, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 316.42, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AR GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81174", "type": "CPT"}], "standard_charges": [{"minimum": 145.04, "maximum": 231.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 145.04, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 231.5, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 194.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 179.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 194.46, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARA-C 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9100", "type": "HCPCS"}, {"code": "691061155", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.62, "maximum": 18.08, "gross_charge": 19.66, "discounted_cash": 24.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 9.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 9.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 9.24, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 14.74, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 14.74, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1.05, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 18.08, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 7.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 14.74, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARBUTAMINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0395", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.23, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARBUTAMINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0395", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARBUTAMINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0395", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARC CANCELLOUS CHIPS", "code_information": [{"code": "771025025", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2935.3, "discounted_cash": 3669.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARCHITECT ECM PX FX 1 SQ CM", "code_information": [{"code": "Q4147", "type": "HCPCS"}], "standard_charges": [{"minimum": 167.83, "maximum": 167.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 167.83, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARCOS 16X150MM SPL TPR DIST", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771038007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5376.54, "maximum": 13740.06, "gross_charge": 14934.85, "discounted_cash": 18668.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 5525.89, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 5525.89, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 5525.89, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 11201.13, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 11201.13, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 13740.06, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 5376.54, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 11201.13, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARCOS CON SZ B STD 80MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "771038009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10429.21, "maximum": 26652.44, "gross_charge": 28970.05, "discounted_cash": 36212.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 10718.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 10718.91, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 10718.91, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 21727.53, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 21727.53, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 26652.44, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 10429.21, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 21727.53, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARCTIC SUN PAD LG", "code_information": [{"code": "771041393", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4428.96, "discounted_cash": 5536.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARCTIC SUN PAD XS", "code_information": [{"code": "771041390", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4428.96, "discounted_cash": 5536.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AREDIA 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2430", "type": "HCPCS"}, {"code": "691060900", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 14.88, "maximum": 56.85, "gross_charge": 61.8, "discounted_cash": 77.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 29.04, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 29.04, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 29.04, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 46.35, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 46.35, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 56.85, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 22.24, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 46.35, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARFORMOTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7605", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.11, "maximum": 14.88, "estimated_discounted_cash": 30.3, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_percentage": 75.0, "possible_amount": 28.04, "count": "1 through 10", "median_amount": 28.04, "methodology": "percent of total billed charges", "10th_percentile": 28.04, "90th_percentile": 28.04}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 28.04, "count": "1 through 10", "median_amount": 28.04, "methodology": "percent of total billed charges", "10th_percentile": 28.04, "90th_percentile": 28.04}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2.11, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 8.42, "count": "1 through 10", "median_amount": 8.42, "methodology": "percent of total billed charges", "10th_percentile": 8.42, "90th_percentile": 8.42}], "billing_class": "facility"}]}, {"description": "ARFORMOTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7605", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 30.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARFORMOTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7605", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 30.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARG II EXT COM/SUP/ACC MISC", "code_information": [{"code": "L8608", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARG II EXT COM/SUP/ACC MISC", "code_information": [{"code": "L8608", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARG II EXT COM/SUP/ACC MISC", "code_information": [{"code": "L8608", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARG II EXT COM/SUP/ACC MISC", "code_information": [{"code": "L8608", "type": "HCPCS"}, {"code": "276", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARG II EXT COM/SUP/ACC MISC", "code_information": [{"code": "L8608", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0892", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.07, "maximum": 3.26, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2.07, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0892", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0892", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS, AUROMED", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0899", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.26, "maximum": 4.71, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS, AUROMED", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0899", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS, AUROMED", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0899", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN ESRD DIALYSIS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0884", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.34, "maximum": 3.26, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN ESRD DIALYSIS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0884", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN ESRD DIALYSIS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0884", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0891", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.68, "maximum": 3.26, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 2.07, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1.82, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0891", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0891", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (AUROMED)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0898", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.31, "maximum": 4.71, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 1.31, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (AUROMED)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0898", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (AUROMED)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0898", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD USE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0883", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.74, "maximum": 3.26, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 3.26, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1.02, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 0.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD USE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0883", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD USE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0883", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGYLE NASAL CPAP CANNULA SMALL", "code_information": [{"code": "771011942", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 252.91, "discounted_cash": 316.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARGYLE REPLOGLE SUCTION CATHETER 6FR", "code_information": [{"code": "771041112", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 92.71, "discounted_cash": 115.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARGYLE REPLOGLE SUCTION CATHETER 8FR", "code_information": [{"code": "771041111", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 92.71, "discounted_cash": 115.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0400", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.62, "maximum": 0.62, "setting": "outpatient", "payers_information": [{"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 0.62, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0400", "type": "HCPCS"}, {"code": "252", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0400", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE LAUROXIL 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1944", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.4, "maximum": 3.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 3.56, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARISTA 1GM", "code_information": [{"code": "771031932", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 317.53, "discounted_cash": 396.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARISTA 3GM HEMOSTATIC", "code_information": [{"code": "771032290", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1319.39, "discounted_cash": 1649.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARISTA 5G", "code_information": [{"code": "771037823", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.82, "discounted_cash": 1664.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARISTA FLEXITIP", "code_information": [{"code": "771031832", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 159.45, "discounted_cash": 199.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARIXTRA 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1652", "type": "HCPCS"}, {"code": "691460810", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.17, "maximum": 16.77, "gross_charge": 18.23, "discounted_cash": 22.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 8.56, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 8.56, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 8.56, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1.4, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 13.67, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 13.67, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 1.17, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 16.77, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 6.56, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 13.67, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARM BOARD PAD", "code_information": [{"code": "771010934", "type": "CDM"}, {"code": "270", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART 1ST ORDR ABD/PEL/EXTR PRCD", "code_information": [{"code": "36245", "type": "CPT"}, {"code": "704305300", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 389.49, "maximum": 8073.31, "gross_charge": 1081.94, "discounted_cash": 1352.43, "setting": 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{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 811.45, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 811.45, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 995.38, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 389.49, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 811.45, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART 1ST ORDR THOR/BRACH PRCD", "code_information": [{"code": "36215", "type": "CPT"}, {"code": "704307522", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 304.5, "maximum": 8073.31, "gross_charge": 845.86, "discounted_cash": 1057.33, "setting": 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{"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 634.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 634.39, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 778.19, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 304.5, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 634.39, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART 2ND ORDR ABD/PEL/EXTR PRCD", "code_information": [{"code": "36246", "type": "CPT"}, {"code": "704307516", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 201.82, "maximum": 8073.31, "gross_charge": 560.62, "discounted_cash": 700.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 370.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 370.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 370.0, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 420.46, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 420.46, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 515.77, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 201.82, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 420.46, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART 2ND ORDR THOR/BRACH PRCD", "code_information": [{"code": "36216", "type": "CPT"}, {"code": "704307586", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 323.22, "maximum": 8073.31, "gross_charge": 897.86, "discounted_cash": 1122.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 592.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 592.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 592.58, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 673.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 673.39, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 826.03, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 323.22, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 673.39, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART 3RD ORDR ABD/PDL/EX PRCD", "code_information": [{"code": "36247", "type": "CPT"}, {"code": "704307572", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 646.97, "maximum": 8073.31, "gross_charge": 1797.14, "discounted_cash": 2246.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 1186.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1186.11, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1186.11, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1347.85, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1347.85, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1653.36, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 646.97, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1347.85, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART 3RD ORDR THOR/BRACH PRCD", "code_information": [{"code": "36217", "type": "CPT"}, {"code": "704308675", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 452.22, "maximum": 8073.31, "gross_charge": 1256.18, "discounted_cash": 1570.23, 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THOR/BRACH PR", "code_information": [{"code": "36218", "type": "CPT"}, {"code": "704307533", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 181.08, "maximum": 8073.31, "gross_charge": 503.02, "discounted_cash": 628.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 331.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 331.99, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 331.99, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue 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"methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 120.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 47.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 97.98, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BLOOD GAS PH,PCO2,PO2 SIM", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "701701242", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 25.29, "maximum": 173.19, "gross_charge": 188.26, "discounted_cash": 235.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue 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"Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 173.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 67.77, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BLOOD GAS PH,PCO2,PO2 SIM", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "701701372", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 25.29, "maximum": 173.19, "gross_charge": 188.26, "discounted_cash": 235.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 173.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 67.77, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BLOOD GAS PH,PCO2,PO2 SIM", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "701701392", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 25.29, "maximum": 173.19, "gross_charge": 188.26, "discounted_cash": 235.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 173.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 67.77, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BLOOD GAS PH,PCO2,PO2 SIM", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "701701565", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 25.29, "maximum": 173.19, "gross_charge": 188.26, "discounted_cash": 235.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 124.25, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 33.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 173.19, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 67.77, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 141.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AOR-CELIAC-MSN-RENAL", "code_information": [{"code": "35631", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue 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billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORSUBCL/CAROT/INNOM", "code_information": [{"code": "35626", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of 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charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBI-ILIAC", "code_information": [{"code": "35638", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBIFEMORAL", "code_information": [{"code": "35646", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOFEMORAL", "code_information": [{"code": "35647", "type": "CPT"}], "standard_charges": [{"minimum": 9473.03, "maximum": 13122.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOILIAC", "code_information": [{"code": "35637", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILL-FEM-FEMORAL", "code_information": [{"code": "35654", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-AXILLARY", "code_information": [{"code": "35650", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-FEMORAL", "code_information": [{"code": "35621", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-POP-TIBIAL", "code_information": [{"code": "35623", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-SUBCLAVIAN", "code_information": [{"code": "35606", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-VERTEBRAL", "code_information": [{"code": "35642", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP COMMON IPSI CAROTID", "code_information": [{"code": "35601", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35566", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35666", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-FEMORAL", "code_information": [{"code": "35661", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-POPLITEAL", "code_information": [{"code": "35656", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AOR/CAROT/INNOM", "code_information": [{"code": "35526", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORCEL/AORMESEN", "code_information": [{"code": "35531", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTBIFEMORAL", "code_information": [{"code": "35540", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOBI-ILIAC", "code_information": [{"code": "35538", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOFEMORAL", "code_information": [{"code": "35539", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOILIAC", "code_information": [{"code": "35537", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTORENAL", "code_information": [{"code": "35560", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-BRACHIAL", "code_information": [{"code": "35522", "type": "CPT"}], "standard_charges": [{"minimum": 9473.03, "maximum": 13122.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-FEMORAL", "code_information": [{"code": "35521", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL/FEM/FEM", "code_information": [{"code": "35533", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILLARY-AXILRY", "code_information": [{"code": "35518", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRACHIAL-BRCHL", "code_information": [{"code": "35525", "type": "CPT"}], "standard_charges": [{"minimum": 9473.03, "maximum": 13122.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRCHL-ULNR-RDL", "code_information": [{"code": "35523", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-BRCHIAL", "code_information": [{"code": "35510", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-VERTBRL", "code_information": [{"code": "35508", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CONTRAL CAROTID", "code_information": [{"code": "35509", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-FEMORAL", "code_information": [{"code": "35558", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35556", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT HEPATORENAL", "code_information": [{"code": "35535", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOFEMORAL", "code_information": [{"code": "35565", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOILIAC", "code_information": [{"code": "35563", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT IPSILAT CAROTID", "code_information": [{"code": "35501", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SPLENORENAL", "code_information": [{"code": "35536", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-AXILARY", "code_information": [{"code": "35516", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-BRCHIAL", "code_information": [{"code": "35512", "type": "CPT"}], "standard_charges": [{"minimum": 9473.03, "maximum": 13122.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-CAROTID", "code_information": [{"code": "35506", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-SUBCLAV", "code_information": [{"code": "35511", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-VERTBRL", "code_information": [{"code": "35515", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-CELIAC", "code_information": [{"code": "35632", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-MESENTERIC", "code_information": [{"code": "35633", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOFEMORAL", "code_information": [{"code": "35665", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOILIAC", "code_information": [{"code": "35663", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIORENAL", "code_information": [{"code": "35634", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35571", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35671", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SPENORENAL", "code_information": [{"code": "35636", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-AXILLARY", "code_information": [{"code": "35616", "type": "CPT"}], "standard_charges": [{"minimum": 9473.03, "maximum": 13122.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-SUBCLAVIAN", "code_information": [{"code": "35612", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-VERTEBRL", "code_information": [{"code": "35645", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP TIBIAL-TIB/PERONEAL", "code_information": [{"code": "35570", "type": "CPT"}], "standard_charges": [{"minimum": 9473.03, "maximum": 13122.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART CATH OR CANNULATION FOR MONITORING", "code_information": [{"code": "36620", "type": "CPT"}, {"code": "704309655", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1473.03, "maximum": 8073.31, "gross_charge": 4091.75, "discounted_cash": 5114.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 2700.55, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2700.55, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2700.55, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 3068.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3068.81, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 3764.41, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 1473.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 3068.81, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART HEART OR PULMNRY PR CODE", "code_information": [{"code": "36013", "type": "CPT"}, {"code": "704307584", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 310.07, "maximum": 8073.31, "gross_charge": 861.32, "discounted_cash": 1076.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 568.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 568.47, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 568.47, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 645.99, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 645.99, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 792.41, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 310.07, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 645.99, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART OR VENOUS BLOOD TUBING", "code_information": [{"code": "A4750", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PANCREAS EXT RECEIVER", "code_information": [{"code": "S1037", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PANCREAS EXT TRANSMITTER", "code_information": [{"code": "S1036", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PANCREAS INV DISP SENSOR", "code_information": [{"code": "S1035", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PANCREAS SYSTEM", "code_information": [{"code": "S1034", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PRESSURE WAVEFORM ANALYS", "code_information": [{"code": "93050", "type": "CPT"}], "standard_charges": [{"minimum": 22.6, "maximum": 102.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 102.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 102.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 102.11, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 102.11, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 48.23, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 22.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ CAROTID SUBCLAV", "code_information": [{"code": "35695", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAV CAROTID", "code_information": [{"code": "35694", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAVIAN", "code_information": [{"code": "35693", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ VERTBRL CAROTID", "code_information": [{"code": "35691", "type": "CPT"}], "standard_charges": [{"minimum": 17292.9, "maximum": 23954.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTACENT AC 1 SQ CM", "code_information": [{"code": "Q4190", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTACENT AC, 1 MG", "code_information": [{"code": "Q4189", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTACENT CORD PER SQ CM", "code_information": [{"code": "Q4216", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTACENT WOUND, PER SQ CM", "code_information": [{"code": "Q4169", "type": "HCPCS"}], "standard_charges": [{"minimum": 219.44, "maximum": 219.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 219.44, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTCLIP FLEXV PRELOADED", "code_information": [{"code": "771036003", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8716.16, "discounted_cash": 10895.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL CANNULA 17FR W/DIALATOR,", "code_information": [{"code": "771005832", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1172.26, "discounted_cash": 1465.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL CANNULA 20FR", "code_information": [{"code": "771032426", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 241.65, "discounted_cash": 302.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL CANNULA 22FR", "code_information": [{"code": "771032427", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 241.65, "discounted_cash": 302.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL CANNULA 24FR", "code_information": [{"code": "771032428", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 241.65, "discounted_cash": 302.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL CANNULATION SUPPORT", "code_information": [{"code": "771004076", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 110.28, "discounted_cash": 137.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL CATHETER LIT 18GA", "code_information": [{"code": "771007628", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 112.4, "discounted_cash": 140.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL DOPP LR UNI LIMITED", "code_information": [{"code": "93926", "type": "CPT"}, {"code": "714060045", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 98.12, "maximum": 668.89, "gross_charge": 726.43, "discounted_cash": 908.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 479.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 479.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 479.44, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 482.87, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 668.89, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 668.89, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 523.73, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 544.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 544.82, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 178.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 668.31, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 106.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 98.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 106.21, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 261.51, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 544.82, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERIAL DOPP UP UNILAT LIMITED", "code_information": [{"code": "93931", "type": "CPT"}, {"code": "714060055", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 98.12, "maximum": 668.31, "gross_charge": 726.43, "discounted_cash": 908.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 479.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 479.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 479.44, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 290.45, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 402.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 402.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 315.03, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 544.82, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 544.82, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 178.08, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 668.31, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 106.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 98.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 106.21, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 261.51, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 544.82, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERIAL DOPPLER LOWER COMPLETE", "code_information": [{"code": "93925", "type": "CPT"}, {"code": "714060040", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 223.03, "maximum": 796.28, "gross_charge": 865.53, "discounted_cash": 1081.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 571.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 571.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 571.24, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 482.87, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 668.89, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 668.89, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 523.73, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 649.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 649.14, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 396.9, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 796.28, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 241.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 223.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 241.43, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 311.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 649.14, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERIAL DOPPLER UPPER", "code_information": [{"code": "93930", "type": "CPT"}, {"code": "714060050", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 223.03, "maximum": 796.28, "gross_charge": 865.53, "discounted_cash": 1081.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 571.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 571.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 571.24, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 290.45, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 402.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 402.35, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 315.03, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 649.14, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 649.14, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 396.9, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 796.28, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 241.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 223.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 241.43, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 311.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 649.14, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERIAL KIT CONNECTOR 17FR", "code_information": [{"code": "771037590", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.61, "discounted_cash": 1325.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL KIT CONNECTOR 21 FR", "code_information": [{"code": "771037591", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1040.49, "discounted_cash": 1300.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL LINE FILTER", "code_information": [{"code": "771025878", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 609.24, "discounted_cash": 761.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL LINE INSERTION", "code_information": [{"code": "703500003", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 328.78, "discounted_cash": 410.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL LINE INSERTION", "code_information": [{"code": "36620", "type": "CPT"}, {"code": "630113770", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 92.56, "maximum": 8073.31, "gross_charge": 257.12, "discounted_cash": 321.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 169.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 169.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 169.69, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 192.84, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 192.84, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 236.55, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 92.56, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 192.84, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERIAL LINE START", "code_information": [{"code": "36620", "type": "CPT"}, {"code": "660520075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 189.46, "maximum": 8073.31, "gross_charge": 526.3, "discounted_cash": 657.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 347.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 347.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 347.35, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 5828.09, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 8073.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 6321.33, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 394.72, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 394.72, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 484.19, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 189.46, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 394.72, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERIAL NEEDLE 18G 27/8", "code_information": [{"code": "771003131", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.54, "discounted_cash": 54.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL PUNCTURE", "code_information": [{"code": "36600", "type": "CPT"}, {"code": "701701955", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 76.87, "maximum": 206.91, "gross_charge": 213.55, "discounted_cash": 266.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 140.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 140.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 140.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 160.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 160.16, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 206.91, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 196.46, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 76.87, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 160.16, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERIAL VENOUS CATH SET FA-04016", "code_information": [{"code": "771025446", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 145.96, "discounted_cash": 182.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERY EXPOS/GRAFT ARTERY", "code_information": [{"code": "33987", "type": "CPT"}], "standard_charges": [{"minimum": 2636.93, "maximum": 3652.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 2636.93, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 3652.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 3652.77, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 2860.09, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY TO VEIN SHUNT", "code_information": [{"code": "36835", "type": "CPT"}], "standard_charges": [{"minimum": 2044.15, "maximum": 13122.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 2044.15, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5162.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2044.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY TRANSPOSE/ENDOVAS TAA", "code_information": [{"code": "33889", "type": "CPT"}], "standard_charges": [{"minimum": 24702.2, "maximum": 34218.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 24702.2, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 34218.48, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 26792.77, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENAL GLAND", "code_information": [{"code": "75731", "type": "CPT"}], "standard_charges": [{"minimum": 86.87, "maximum": 5162.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 86.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 5162.92, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 86.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS CHEST", "code_information": [{"code": "75756", "type": "CPT"}], "standard_charges": [{"minimum": 250.5, "maximum": 6074.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 250.5, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 6074.02, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 2904.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 3143.67, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN AUTOGRAFT", "code_information": [{"code": "36825", "type": "CPT"}], "standard_charges": [{"minimum": 2703.01, "maximum": 13122.43, "estimated_discounted_cash": 18621.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 2703.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8901.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5399.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2703.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4987.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5399.11, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN NONAUTOGRAFT", "code_information": [{"code": "36830", "type": "CPT"}], "standard_charges": [{"minimum": 2703.01, "maximum": 13122.43, "estimated_discounted_cash": 18951.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 2703.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_percentage": 66.0, "possible_amount": 5044.83, "count": "1 through 10", "median_amount": 5044.83, "methodology": "percent of total billed charges", "10th_percentile": 5044.83, "90th_percentile": 5044.83}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 9473.03, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 13122.43, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 10274.75, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 8901.06, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 5399.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2703.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 4987.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 5399.11, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHERECTOMY, ILIAC ARTERY", "code_information": [{"code": "238T", "type": "CPT"}, {"code": "704301727", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 3449.88, "maximum": 28402.43, "gross_charge": 9583.01, "discounted_cash": 11978.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 6324.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 6324.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 6324.78, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 17292.9, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 23954.82, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 18756.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 7187.25, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7187.25, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 28402.43, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 8816.36, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 17934.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16568.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 17934.83, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 3449.88, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 7187.25, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHEREX FIBER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771026671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.39, "maximum": 200.34, "gross_charge": 217.77, "discounted_cash": 272.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 80.57, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 80.57, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 80.57, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 163.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 163.32, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 200.34, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 78.39, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 163.32, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHOCELL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771037386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2975.87, "maximum": 7605.01, "gross_charge": 8266.32, "discounted_cash": 10332.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 3058.53, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 3058.53, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 3058.53, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 6199.74, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 6199.74, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 7605.01, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 2975.87, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 6199.74, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHOCENTESIS (KNEE, HIP, SHOULDER)", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "704109632", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 30.21, "maximum": 1362.02, "gross_charge": 962.49, "discounted_cash": 1203.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 30.21, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 635.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 635.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 635.24, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 983.24, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1362.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1362.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1066.45, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 721.86, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 721.86, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 479.74, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 885.49, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 294.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 30.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 272.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 294.83, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 346.49, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 721.86, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHOCENTESIS (WRIST, ELBOW, ANKLE)", "code_information": [{"code": "20605", "type": "CPT"}, {"code": "704109633", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 25.86, "maximum": 1362.02, "gross_charge": 962.49, "discounted_cash": 1203.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 25.86, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 635.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 635.24, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 635.24, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 983.24, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 1362.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 1362.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 1066.45, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 721.86, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 721.86, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 479.74, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 885.49, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 294.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 25.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 272.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 294.83, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 346.49, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 721.86, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHOGRAM ANKLE PR CODE", "code_information": [{"code": "27648", "type": "CPT"}, {"code": "704107368", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 70.8, "maximum": 949.7, "gross_charge": 196.69, "discounted_cash": 245.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 129.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 129.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 129.81, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 685.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 949.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 949.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 743.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 147.51, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 147.51, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 180.95, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 70.8, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 147.51, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHOGRAM ELBOW PR CODE", "code_information": [{"code": "24220", "type": "CPT"}, {"code": "704107385", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 70.8, "maximum": 180.95, "gross_charge": 196.69, "discounted_cash": 245.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 129.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 129.81, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 129.81, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 147.51, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 147.51, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 180.95, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 70.8, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 147.51, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHOGRAM KNEE PR CODE CT/MRI", "code_information": [{"code": "27369", "type": "CPT"}, {"code": "704107397", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 67.75, "maximum": 173.16, "gross_charge": 188.22, "discounted_cash": 235.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 124.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 124.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 124.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 141.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 141.16, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 173.16, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 67.75, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 141.16, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHOGRAM SHOULDER PR CODE", "code_information": [{"code": "23350", "type": "CPT"}, {"code": "704107340", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 80.41, "maximum": 205.5, "gross_charge": 223.38, "discounted_cash": 279.23, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 147.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 147.43, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 147.43, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 167.53, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 167.53, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 205.5, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 80.41, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 167.53, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHOGRAM TMJ PR CODE", "code_information": [{"code": "704107032", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 13827.93, "discounted_cash": 17284.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTHOGRAM WRIST PR CODE", "code_information": [{"code": "25246", "type": "CPT"}, {"code": "704102546", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 62.2, "maximum": 949.7, "gross_charge": 172.8, "discounted_cash": 216.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 114.04, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 114.04, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 114.04, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 685.59, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 949.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 949.7, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 743.61, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 129.6, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 129.6, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 158.97, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 62.2, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 129.6, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHR SI JT OPN B1GRF INSTRM", "code_information": [{"code": "27280", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 2-3 VRT SGM", "code_information": [{"code": "22808", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 4-7 VRT SGM", "code_information": [{"code": "22810", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 8+ VRT SGM", "code_information": [{"code": "22812", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD CERVICAL EA", "code_information": [{"code": "22552", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "estimated_discounted_cash": 100.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_percentage": 75.0, "possible_amount": 70.1, "count": "1 through 10", "median_amount": 70.1, "methodology": "percent of total billed charges", "10th_percentile": 70.1, "90th_percentile": 70.1}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 70.1, "count": "1 through 10", "median_amount": 70.1, "methodology": "percent of total billed charges", "10th_percentile": 70.1, "90th_percentile": 70.1}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC CRV", "code_information": [{"code": "22554", "type": "CPT"}], "standard_charges": [{"minimum": 11872.0, "maximum": 21317.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21317.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11872.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC EA", "code_information": [{"code": "22585", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC LUM", "code_information": [{"code": "22558", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC THC", "code_information": [{"code": "22556", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBDY CERVICAL", "code_information": [{"code": "22551", "type": "CPT"}], "standard_charges": [{"minimum": 11872.0, "maximum": 21317.69, "estimated_discounted_cash": 18617.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_percentage": 75.0, "possible_amount": 13070.59, "count": "1 through 10", "median_amount": 13070.59, "methodology": "percent of total billed charges", "10th_percentile": 13070.59, "90th_percentile": 13070.59}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 13070.59, "count": "1 through 10", "median_amount": 13070.59, "methodology": "percent of total billed charges", "10th_percentile": 13070.59, "90th_percentile": 13070.59}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21317.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11872.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_percentage": 75.0, "possible_amount": 12840.21, "count": "1 through 10", "median_amount": 12840.21, "methodology": "percent of total billed charges", "10th_percentile": 12840.21, "90th_percentile": 12840.21}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT TORAL/XORAL C1-C2", "code_information": [{"code": "22548", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD CMBN 1NTRSPC EA ADDL", "code_information": [{"code": "22634", "type": "CPT"}], "standard_charges": [{"minimum": 8089.31, "maximum": 11205.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD CMBN 1NTRSPC LUMBAR", "code_information": [{"code": "22633", "type": "CPT"}], "standard_charges": [{"minimum": 8089.31, "maximum": 30185.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 8089.31, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 11205.64, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 8773.91, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 30185.68, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16968.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD GLENOHUMERAL JT W/GRF", "code_information": [{"code": "23802", "type": "CPT"}], "standard_charges": [{"minimum": 5957.63, "maximum": 21317.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 5957.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 21317.69, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5957.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 11872.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 12851.14, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD HIP JT SBTRCHC OSTEOT", "code_information": [{"code": "27286", "type": "CPT"}], "standard_charges": [{"minimum": 11781.14, "maximum": 16319.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11781.14, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16319.71, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12778.19, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ EA AD", "code_information": [{"code": "22534", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ LMBR", "code_information": [{"code": "22533", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ THRC", "code_information": [{"code": "22532", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD POSTERIOR/PSTLAT TQ 1NTRSPC LUMB", "code_information": [{"code": "22612", "type": "CPT"}, {"code": "704355599", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 12183.33, "maximum": 39209.3, "gross_charge": 42618.81, "discounted_cash": 53273.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 30185.68, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 39209.3, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16968.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 15342.77, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PRE-SAC NTRBDY L5-S1", "code_information": [{"code": "22586", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 13+ VRT SGM", "code_information": [{"code": "22804", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 7-12 VRT SGM", "code_information": [{"code": "22802", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM<6 VRT SGM", "code_information": [{"code": "22800", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC CRV", "code_information": [{"code": "22600", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC EA ADL NTRSPC", "code_information": [{"code": "22614", "type": "CPT"}, {"code": "704355600", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 12183.33, "maximum": 39209.3, "gross_charge": 42618.81, "discounted_cash": 53273.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 39209.3, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 15342.77, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LM EA", "code_information": [{"code": "22632", "type": "CPT"}, {"code": "704355595", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 12183.33, "maximum": 39209.3, "gross_charge": 42618.81, "discounted_cash": 53273.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 39209.3, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 15342.77, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LUM", "code_information": [{"code": "22630", "type": "CPT"}, {"code": "704355594", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 12183.33, "maximum": 39209.3, "gross_charge": 42618.81, "discounted_cash": 53273.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 28128.41, "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 30185.68, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 39209.3, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16968.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 15342.77, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 31964.1, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC THRC", "code_information": [{"code": "22610", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ ATLAS-AXIS", "code_information": [{"code": "22595", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ CRANIOCERVICAL", "code_information": [{"code": "22590", "type": "CPT"}], "standard_charges": [{"minimum": 12183.33, "maximum": 16876.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 12183.33, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 16876.84, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 13214.42, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PERQ/MIN NVAS", "code_information": [{"code": "27279", "type": "CPT"}], "standard_charges": [{"minimum": 11179.78, "maximum": 30185.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Better Health CVS", "standard_charge_dollar": 13630.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 11179.78, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 15486.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 15486.69, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 12125.94, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthChoice", "plan_name": "PPO", "standard_charge_dollar": 30185.68, "methodology": "fee schedule"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 13630.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16968.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PRQ WO TFXJ DEV", "code_information": [{"code": "27278", "type": "CPT"}], "standard_charges": [{"minimum": 16968.19, "maximum": 48958.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Advantage PPO", "standard_charge_dollar": 35343.02, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Choice PPO", "standard_charge_dollar": 48958.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "MA", "standard_charge_dollar": 48958.58, "methodology": "case rate"}, {"payer_name": "Blue Cross Blue Shield of Oklahoma", "plan_name": "Preferred PPO", "standard_charge_dollar": 38334.14, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 92.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "MA", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Military", "standard_charge_dollar": 16968.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "PPO", "standard_charge_dollar": 18367.63, "methodology": "fee schedule"}, {"payer_name": "Medica", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHREX 45 RIGHT SUT. LASSO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771029261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 430.46, "maximum": 1100.08, "gross_charge": 1195.74, "discounted_cash": 1494.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 442.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 442.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 442.42, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 896.8, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 896.8, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1100.08, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 430.46, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 896.8, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHREX ABILATOR", "code_information": [{"code": "771026325", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1361.54, "discounted_cash": 1701.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTHREX ACL INSTRUMENT", "code_information": [{"code": "660520080", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5534.07, "discounted_cash": 6917.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTHREX BIO CORKSCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771029262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 728.92, "maximum": 1862.79, "gross_charge": 2024.78, "discounted_cash": 2530.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 749.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 749.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 749.16, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1518.58, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1518.58, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1862.79, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 728.92, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1518.58, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHREX BIO TENDON SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771030982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 678.83, "maximum": 1734.8, "gross_charge": 1885.66, "discounted_cash": 2357.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 697.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 697.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 697.69, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1414.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1414.24, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 1734.8, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 678.83, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "PPO", "standard_charge_dollar": 1414.24, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHREX BIOTENODESIS SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "771025428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 785.57, "maximum": 2007.56, "gross_charge": 2182.14, "discounted_cash": 2727.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "MA", "standard_charge_dollar": 807.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 807.39, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 807.39, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "POS", "standard_charge_dollar": 1636.6, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1636.6, "methodology": "percent of total billed charges"}, {"payer_name": "HealthSmart", "plan_name": "PPO", "standard_charge_dollar": 2007.56, "methodology": "percent of total billed charges"}, {"payer_name": "Medica", "plan_name": "All Plans", "standard_charge_dollar": 785.57, 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