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],"standard_charges":[{"minimum":720.3000,"maximum":1443.0000,"gross_charge":1950.0000,"setting":"inpatient","payers_information":[{"payer_name":"PLAN DE SALUD MENONITA VITAL","plan_name":"MENONITA VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":720.3000,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":757.0900,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":757.0900,"methodology":"per diem"},{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":761.2500,"methodology":"per diem"},{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":761.2500,"methodology":"per diem"},{"payer_name":"SSS VITAL","plan_name":"SSS VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":772.0000,"methodology":"per diem"},{"payer_name":"AUXILIO","plan_name":"AUXILIO PLUS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":866.0000,"methodology":"per diem"},{"payer_name":"INTERNATIONAL MEDICAL CARD","plan_name":"INTERNATIONAL MEDICAL CARD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":937.0000,"methodology":"per diem"},{"payer_name":"HUMANA ADVANTAGE","plan_name":"CHOICE HUMANA GOLD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":940.0000,"methodology":"per diem"},{"payer_name":"HUMANA ADVANTAGE","plan_name":"HUMANA ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":940.0000,"methodology":"per diem"},{"payer_name":"SSS SELECTIVE","plan_name":"SSS SELECTIVE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":984.0000,"methodology":"per diem"},{"payer_name":"CHOICE MMM","plan_name":"CHOICE MMM","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"MMM ADVANTAGE","plan_name":"MMM ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1025.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1098.0000,"methodology":"per diem"},{"payer_name":"SSS BLUE CROSS","plan_name":"SSS BLUE CROSS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1113.0000,"methodology":"per diem"},{"payer_name":"SSS BLUE CROSS","plan_name":"SSS BLUE CROSS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1113.0000,"methodology":"per diem"},{"payer_name":"SSS","plan_name":"SSS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1113.0000,"methodology":"per diem"},{"payer_name":"CORVEL","plan_name":"CORVEL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1443.0000,"methodology":"per diem"}],"additional_generic_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available."}]},{"description":"SEMI PRIVATE ROOM","code_information":[ { "code": "120", "type": "RC" } ],"standard_charges":[{"minimum":720.3000,"maximum":1443.0000,"gross_charge":470.0000,"setting":"inpatient","payers_information":[{"payer_name":"PLAN DE SALUD MENONITA VITAL","plan_name":"MENONITA VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":720.3000,"methodology":"per diem"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":735.0000,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":757.0900,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":757.0900,"methodology":"per diem"},{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":761.2500,"methodology":"per diem"},{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":761.2500,"methodology":"per diem"},{"payer_name":"SSS VITAL","plan_name":"SSS VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":772.0000,"methodology":"per diem"},{"payer_name":"AUXILIO","plan_name":"AUXILIO PLUS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":866.0000,"methodology":"per diem"},{"payer_name":"HUMANA ADVANTAGE","plan_name":"CHOICE HUMANA GOLD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":940.0000,"methodology":"per diem"},{"payer_name":"HUMANA ADVANTAGE","plan_name":"HUMANA ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":940.0000,"methodology":"per diem"},{"payer_name":"UTM","plan_name":"UTM","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":960.0000,"methodology":"per diem"},{"payer_name":"INTERNATIONAL MEDICAL CARD","plan_name":"INTERNATIONAL MEDICAL CARD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":974.0000,"methodology":"per diem"},{"payer_name":"SSS SELECTIVE","plan_name":"SSS SELECTIVE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":984.0000,"methodology":"per diem"},{"payer_name":"CHOICE MMM","plan_name":"CHOICE MMM","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"CHOICE MMM","plan_name":"CHOICE MMM","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"MMM ADVANTAGE","plan_name":"MMM ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1098.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1125.0000,"methodology":"per diem"},{"payer_name":"SSS BLUE CROSS","plan_name":"SSS BLUE CROSS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1113.0000,"methodology":"per diem"},{"payer_name":"SSS BLUE CROSS","plan_name":"SSS BLUE CROSS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1113.0000,"methodology":"per diem"},{"payer_name":"SSS","plan_name":"SSS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1113.0000,"methodology":"per diem"},{"payer_name":"CORVEL","plan_name":"CORVEL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1443.0000,"methodology":"per diem"}],"additional_generic_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available."}]},{"description":"ISOLATION ROOM","code_information":[ { "code": "164", "type": "RC" } ],"standard_charges":[{"minimum":720.3000,"maximum":1519.0000,"gross_charge":600.0000,"setting":"inpatient","payers_information":[{"payer_name":"PLAN DE SALUD MENONITA VITAL","plan_name":"MENONITA VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":720.3000,"methodology":"per diem"},{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":761.2500,"methodology":"per diem"},{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":761.2500,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":768.6600,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":768.6600,"methodology":"per diem"},{"payer_name":"AUXILIO","plan_name":"AUXILIO PLUS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":866.0000,"methodology":"per diem"},{"payer_name":"SSS VITAL","plan_name":"SSS VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":899.0000,"methodology":"per diem"},{"payer_name":"HUMANA ADVANTAGE","plan_name":"CHOICE HUMANA GOLD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":955.0000,"methodology":"per diem"},{"payer_name":"HUMANA ADVANTAGE","plan_name":"HUMANA ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":955.0000,"methodology":"per diem"},{"payer_name":"UTM","plan_name":"UTM","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":960.0000,"methodology":"per diem"},{"payer_name":"INTERNATIONAL MEDICAL CARD","plan_name":"INTERNATIONAL MEDICAL CARD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":974.0000,"methodology":"per diem"},{"payer_name":"SSS SELECTIVE","plan_name":"SSS SELECTIVE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":984.0000,"methodology":"per diem"},{"payer_name":"CHOICE MMM","plan_name":"CHOICE MMM","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"MMM ADVANTAGE","plan_name":"MMM ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1025.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1098.0000,"methodology":"per diem"},{"payer_name":"SSS BLUE CROSS","plan_name":"SSS BLUE CROSS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1113.0000,"methodology":"per diem"},{"payer_name":"SSS","plan_name":"SSS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1113.0000,"methodology":"per diem"},{"payer_name":"CORVEL","plan_name":"CORVEL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1519.0000,"methodology":"per diem"}],"additional_generic_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available."}]},{"description":"NICU UNIT","code_information":[ { "code": "174", "type": "RC" } ],"standard_charges":[{"minimum":840.0000,"maximum":1821.0000,"gross_charge":650.0000,"setting":"inpatient","payers_information":[{"payer_name":"PLAN DE SALUD MENONITA VITAL","plan_name":"MENONITA VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":840.0000,"methodology":"per diem"},{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":882.0000,"methodology":"per diem"},{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":882.0000,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":882.1200,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":882.1200,"methodology":"per diem"},{"payer_name":"AUXILIO","plan_name":"AUXILIO PLUS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1019.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1025.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1120.0000,"methodology":"per diem"},{"payer_name":"SSS VITAL","plan_name":"SSS VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1043.0000,"methodology":"per diem"},{"payer_name":"INTERNATIONAL MEDICAL CARD","plan_name":"INTERNATIONAL MEDICAL CARD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1102.0000,"methodology":"per diem"},{"payer_name":"SSS SELECTIVE","plan_name":"SSS SELECTIVE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1154.0000,"methodology":"per diem"},{"payer_name":"SSS BLUE CROSS","plan_name":"SSS BLUE CROSS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1319.0000,"methodology":"per diem"},{"payer_name":"SSS","plan_name":"SSS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1319.0000,"methodology":"per diem"},{"payer_name":"CORVEL","plan_name":"CORVEL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1821.0000,"methodology":"per diem"}],"additional_generic_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available."}]},{"description":"INTENSIVE CARE UNIT","code_information":[ { "code": "200", "type": "RC" } ],"standard_charges":[{"minimum":882.0000,"maximum":1821.0000,"gross_charge":650.0000,"setting":"inpatient","payers_information":[{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":882.0000,"methodology":"per diem"},{"payer_name":"MMM VITAL","plan_name":"MMM VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":882.0000,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":882.1200,"methodology":"per diem"},{"payer_name":"FIRST MEDICAL VITAL","plan_name":"FIRST MEDICAL VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":882.1200,"methodology":"per diem"},{"payer_name":"SSS VITAL","plan_name":"SSS VITAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":899.0000,"methodology":"per diem"},{"payer_name":"HUMANA ADVANTAGE","plan_name":"CHOICE HUMANA GOLD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":955.0000,"methodology":"per diem"},{"payer_name":"HUMANA ADVANTAGE","plan_name":"HUMANA ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":955.0000,"methodology":"per diem"},{"payer_name":"AUXILIO","plan_name":"AUXILIO PLUS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1019.0000,"methodology":"per diem"},{"payer_name":"CHOICE MMM","plan_name":"CHOICE MMM","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"CHOICE MMM","plan_name":"CHOICE MMM","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"MMM ADVANTAGE","plan_name":"MMM ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1020.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1025.0000,"methodology":"per diem"},{"payer_name":"MEDICAL CARD SYSTEM","plan_name":"MCS ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1120.0000,"methodology":"per diem"},{"payer_name":"INTERNATIONAL MEDICAL CARD","plan_name":"INTERNATIONAL MEDICAL CARD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1102.0000,"methodology":"per diem"},{"payer_name":"UTM","plan_name":"UTM","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1105.0000,"methodology":"per diem"},{"payer_name":"SSS SELECTIVE","plan_name":"SSS SELECTIVE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1154.0000,"methodology":"per diem"},{"payer_name":"SSS BLUE CROSS","plan_name":"SSS BLUE CROSS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1294.0000,"methodology":"per diem"},{"payer_name":"SSS BLUE CROSS","plan_name":"SSS BLUE CROSS","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1294.0000,"methodology":"per diem"},{"payer_name":"SSS","plan_name":"SSS COMERCIAL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1294.0000,"methodology":"per diem"},{"payer_name":"CORVEL","plan_name":"CORVEL","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":1821.0000,"methodology":"per diem"}],"additional_generic_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available."}]},{"description":"INTENSIVE CARE POST ICU","code_information":[ { "code": "206", "type": "RC" } ],"standard_charges":[{"minimum":955.0000,"maximum":955.0000,"gross_charge":530.0000,"setting":"inpatient","payers_information":[{"payer_name":"HUMANA ADVANTAGE","plan_name":"CHOICE HUMANA GOLD","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":955.0000,"methodology":"per diem"},{"payer_name":"HUMANA ADVANTAGE","plan_name":"HUMANA ADVANTAGE","additional_payer_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available.","standard_charge_dollar":955.0000,"methodology":"per diem"}],"additional_generic_notes":"In these circumstances, the service may be packaged\/bundled into a separate rate or priced through a separate carrier where the rate was not available."}]}]}