{"hospital_name":"Hospital Pavia Santurce","last_updated_on":"2025-04-10","version":"3.0.0","location_name":["Hospital Pavia Santurce"],"hospital_address":["Calle Profesor Augusto Rodriguez 1462, Santurce, PR 00910"],"type_2_npi":[""],"license_information":{"license_number":"60","state":"PR"},"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.","attester_name":"","confirm_attestation":true},"standard_charge_information":[{"description":"Biopsy of Prostate Using Needle","code_information":[ { "code": "55700", "type": "CPT" } ],"standard_charges":[{"minimum":400.0000,"maximum":900.0000,"gross_charge":797.5000,"discounted_cash":797.5000,"setting":"outpatient","payers_information":[{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":400.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":900.0000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Abdomen and Pelvis With Contrast","code_information":[ { "code": "74177", "type": "CPT" } ],"standard_charges":[{"minimum":68.7500,"maximum":450.0000,"gross_charge":954.9700,"discounted_cash":954.9700,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":93.8400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":279.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":162.8700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":251.4700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":83.4700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":159.5400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":320.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":197.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":104.6200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":144.7100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":191.2500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":111.7300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":139.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":272.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":225.4800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":225.4800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":93.8400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":240.8100,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Head or Brain Without Contrast","code_information":[ { "code": "70450", "type": "CPT" } ],"standard_charges":[{"minimum":36.5000,"maximum":450.0000,"gross_charge":703.4000,"discounted_cash":703.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":43.6700,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":183.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":112.1800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":74.9100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":36.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":59.3000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":39.0900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":53.9000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":47.4600,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":53.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":75.0300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":75.0300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":43.6700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":74.2000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Pelvis With Contrast","code_information":[ { "code": "72193", "type": "CPT" } ],"standard_charges":[{"minimum":59.9100,"maximum":450.0000,"gross_charge":786.1100,"discounted_cash":786.1100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":59.9100,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":147.7200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":180.0700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":72.5600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":115.6100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":142.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":142.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":75.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":102.3700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":92.5300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":114.8500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":99.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":171.4600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":171.4600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":59.9100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":183.7000,"methodology":"fee schedule"}]}]},{"description":"Complete Ultrasound of Abdomen","code_information":[ { "code": "76700", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":150.0000,"gross_charge":264.8900,"discounted_cash":264.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":92.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":41.5100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":65.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":58.3800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":85.4600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":33.4000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":63.1100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":71.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":41.4700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":56.3000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":44.2000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":47.5600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":55.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":59.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":84.8200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":84.8200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":41.5100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":84.0300,"methodology":"fee schedule"}]}]},{"description":"Diagnostic Mammogram of Both Breasts","code_information":[ { "code": "77066", "type": "CPT" } ],"standard_charges":[{"minimum":24.6300,"maximum":151.1700,"gross_charge":290.0000,"discounted_cash":290.0000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":51.6100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":24.6300,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":84.2300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":84.2300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":86.4100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":117.8200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":50.4700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":121.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":81.6700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":52.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":46.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":123.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":58.5100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":76.9100,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":151.1700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":42.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":78.8200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":42.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":74.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":93.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":57.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":123.6100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":123.6100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":123.6100,"methodology":"fee schedule"}]}]},{"description":"Diagnostic Mammogram of One Breast","code_information":[ { "code": "77065", "type": "CPT" } ],"standard_charges":[{"minimum":12.0000,"maximum":203.8000,"gross_charge":225.0000,"discounted_cash":225.0000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":41.8600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":67.2800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":67.2800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":68.2900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":92.1400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":43.2600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":95.3000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":63.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":42.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":37.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":34.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":96.7900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":46.8200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":61.4400,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":203.8000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":62.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":32.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":59.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":74.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":41.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":96.7900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":96.7900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":96.7900,"methodology":"fee schedule"}]}]},{"description":"Exam of Entire Large Intestine Using Colonoscope","code_information":[ { "code": "45378", "type": "CPT" } ],"standard_charges":[{"minimum":72.7300,"maximum":200.0000,"gross_charge":234.4300,"discounted_cash":234.4300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":72.7300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":200.0000,"methodology":"fee schedule"}]}]},{"description":"Exam of Left Heart with Catheter Insertion","code_information":[ { "code": "93452", "type": "CPT" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2698.0000,"gross_charge":1125.0000,"discounted_cash":1125.0000,"setting":"outpatient","payers_information":[{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":2698.0000,"methodology":"fee schedule"}]}]},{"description":"External Ultrasound of Pregnant Uterus in 2nd or 3rd Trimester","code_information":[ { "code": "76805", "type": "CPT" } ],"standard_charges":[{"minimum":17.5000,"maximum":150.0000,"gross_charge":198.7300,"discounted_cash":198.7300,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":87.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":51.6000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":18.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":53.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":44.9700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":94.9600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":41.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":36.5700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":74.4100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":56.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":48.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":65.7600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":51.4100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":18.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":47.0900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":65.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":53.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":94.9700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":94.9700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":51.6000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":92.3900,"methodology":"fee schedule"}]}]},{"description":"Individual Physical Therapy Exercises","code_information":[ { "code": "97110", "type": "CPT" } ],"standard_charges":[{"minimum":10.7300,"maximum":27.1200,"gross_charge":20.0000,"discounted_cash":20.0000,"setting":"outpatient","payers_information":[{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":18.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":22.7700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":27.1200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":27.1200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":23.1200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":27.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":27.1200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":27.1200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Basic Metabolic Panel with Total Calcium","code_information":[ { "code": "80048", "type": "CPT" } ],"standard_charges":[{"minimum":7.6900,"maximum":40.0000,"gross_charge":76.8700,"discounted_cash":76.8700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":10.4400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":15.2000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":8.4600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.0600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":10.4400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":11.7600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":8.4600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":7.6900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.1900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":8.7000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":9.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":10.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":9.4000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":10.4400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.4600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Cholesterol Panel","code_information":[ { "code": "80061", "type": "CPT" } ],"standard_charges":[{"minimum":12.1700,"maximum":60.0000,"gross_charge":93.2900,"discounted_cash":93.2900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":18.8500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":42.5800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":18.8500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":12.7700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":25.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":18.8500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.1700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.7000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":18.2400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":18.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":21.1400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":17.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":26.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":21.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":18.8500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":18.2700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":18.8500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Complete Blood Cell Count With White Blood Cell Percentage","code_information":[ { "code": "85025", "type": "CPT" } ],"standard_charges":[{"minimum":6.6400,"maximum":16.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.5900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.4500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.7700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":9.5900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.7700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":6.6400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.4400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":10.5900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.0500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":9.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":8.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.6300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":9.5900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.7700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Complete Blood Cell Count Without White Blood Cell Percentage","code_information":[ { "code": "85027", "type": "CPT" } ],"standard_charges":[{"minimum":4.8000,"maximum":14.2500,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.9800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":5.8500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":7.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.9100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":5.2200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.0300,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":4.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.1800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":7.9800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":8.8100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Comprehensive Metabolic Panel","code_information":[ { "code": "80053", "type": "CPT" } ],"standard_charges":[{"minimum":9.6000,"maximum":80.0000,"gross_charge":100.0000,"discounted_cash":100.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":19.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.6000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.0400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":23.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":10.5600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.0700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":13.0400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":10.5600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.6000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":11.4800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":13.0200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":14.3900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.5600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":16.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":11.7400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":13.0400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":10.5600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Free Prostate Specific Antigen Level","code_information":[ { "code": "84154", "type": "CPT" } ],"standard_charges":[{"minimum":16.7200,"maximum":145.0000,"gross_charge":318.6800,"discounted_cash":318.6800,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":33.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":22.7100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":42.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":18.3900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":17.5400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.3900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":145.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":25.4200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":25.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":25.0600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":18.3900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":16.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.9800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":25.7000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":25.0600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":17.5400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":30.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":21.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":29.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":27.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.4400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.7100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":18.3900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":120.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Identification of COVID-19 Antibody","code_information":[ { "code": "86769", "type": "CPT" } ],"standard_charges":[{"minimum":19.0000,"maximum":62.0000,"gross_charge":45.0000,"discounted_cash":45.0000,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":42.1300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":42.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":42.1300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":62.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":43.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":42.1300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":29.4900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":42.1300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":42.1300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Identification of COVID-19 Virus DNA Using Amplified Probe Technique","code_information":[ { "code": "87635", "type": "CPT" } ],"standard_charges":[{"minimum":51.3300,"maximum":76.3300,"gross_charge":171.3300,"discounted_cash":171.3300,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":76.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":76.3300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Identification Of COVID-19 Virus Using Multiple-Step Immunoassay Method","code_information":[ { "code": "87426", "type": "CPT" } ],"standard_charges":[{"minimum":45.2300,"maximum":45.2300,"gross_charge":75.0000,"discounted_cash":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Kidney Function Panel","code_information":[ { "code": "80069", "type": "CPT" } ],"standard_charges":[{"minimum":7.8900,"maximum":53.0000,"gross_charge":40.0000,"discounted_cash":40.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.1100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":13.1400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":10.7200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":8.6800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.2800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":10.7200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":8.6800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":7.8900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.4300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":12.2100,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":10.9200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":8.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.7400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":11.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":10.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":9.6500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":10.7200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Liver Function Panel","code_information":[ { "code": "80076", "type": "CPT" } ],"standard_charges":[{"minimum":7.4300,"maximum":80.0000,"gross_charge":70.2100,"discounted_cash":70.2100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":13.6000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":14.8000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":13.0700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":10.0900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":30.4200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":8.1700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":7.7900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":10.0900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.2100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":8.1700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":7.4300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.8800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.6000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":8.7000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":7.7900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.5800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":9.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":12.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":11.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":9.0800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":10.0900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.1700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Machine Analysis of Urine By Dipstick","code_information":[ { "code": "81003", "type": "CPT" } ],"standard_charges":[{"minimum":2.0400,"maximum":8.0000,"gross_charge":12.6100,"discounted_cash":12.6100,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":2.7700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":2.7700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":2.0400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":2.4400,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":3.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":3.2200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":2.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":2.7700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":3.0600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Machine Analysis of Urine By Dipstick with Microscope Evaluation","code_information":[ { "code": "81001", "type": "CPT" } ],"standard_charges":[{"minimum":2.8800,"maximum":8.0000,"gross_charge":23.2000,"discounted_cash":23.2000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.3800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.8300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":3.9200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.6000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.1700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.4600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":3.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.1700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":2.8800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":3.4500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":4.3200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.1600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":3.5200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":3.9200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.1700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":4.3100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Manual Analysis of Urine By Dipstick With Microscope Evaluation","code_information":[ { "code": "81000", "type": "CPT" } ],"standard_charges":[{"minimum":2.9200,"maximum":16.0000,"gross_charge":12.0000,"discounted_cash":12.0000,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.3800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":6.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":2.9200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":4.3200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Prothrombin Time","code_information":[ { "code": "85610", "type": "CPT" } ],"standard_charges":[{"minimum":3.5800,"maximum":20.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.8500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.8300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.2900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.7500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":4.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.2900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.5800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.4500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":5.3600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":3.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.3100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.3700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.8500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.2900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Panel for Pregnant Patients without HIV Testing","code_information":[ { "code": "80055", "type": "CPT" } ],"standard_charges":[{"minimum":45.0000,"maximum":175.0000,"gross_charge":75.0000,"discounted_cash":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":54.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":54.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":51.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":60.8300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":54.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":45.5800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":72.5600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":65.1200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":54.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":51.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":45.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":53.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":53.1200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Thromboplastin Time","code_information":[ { "code": "85730", "type": "CPT" } ],"standard_charges":[{"minimum":5.1900,"maximum":20.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.4200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.0100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":5.7300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":7.4200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.0100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":5.1900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":6.5300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":8.1800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":5.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.3000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":6.6700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":7.4200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.0100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Thyroid Stimulating Hormone Level","code_information":[ { "code": "84443", "type": "CPT" } ],"standard_charges":[{"minimum":15.2800,"maximum":42.7500,"gross_charge":116.6200,"discounted_cash":116.6200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":20.7500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":42.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":16.0200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":20.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":15.2800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":18.2600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":22.8900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":22.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":30.0300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":24.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":18.6700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":20.7500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Prostate Specific Antigen Level","code_information":[ { "code": "84153", "type": "CPT" } ],"standard_charges":[{"minimum":20.9100,"maximum":120.0000,"gross_charge":29.7500,"discounted_cash":29.7500,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":33.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":25.0900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":42.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":25.0900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":26.2700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":25.0900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":58.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":25.0900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":20.9100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.8200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":25.0900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":26.2700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":30.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":23.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":33.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":31.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.0900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":25.0900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":25.0900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"}]}]},{"description":"MRI of Brain With and Without Contrast","code_information":[ { "code": "70553", "type": "CPT" } ],"standard_charges":[{"minimum":101.5200,"maximum":1300.0000,"gross_charge":1788.0900,"discounted_cash":1788.0900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":302.0600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":251.8200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":101.5200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":255.3600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":553.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":362.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":310.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":193.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":127.0100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":165.8500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":328.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":155.0400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":240.9400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":165.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":270.4200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":270.4200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":255.3600,"methodology":"fee schedule"}]}]},{"description":"MRI of Leg Joint Without Contrast","code_information":[ { "code": "73721", "type": "CPT" } ],"standard_charges":[{"minimum":70.0200,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":193.3700,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":70.0200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":240.1700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":162.8300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":72.5400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":121.7400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":238.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":79.6800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":103.4200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":97.4300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":102.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":173.6300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":173.6300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":70.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":164.4200,"methodology":"fee schedule"}]}]},{"description":"MRI of Lower Spinal Canal Without Contrast","code_information":[ { "code": "72148", "type": "CPT" } ],"standard_charges":[{"minimum":69.0500,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":193.3700,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":76.5100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":238.1100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":144.5500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":69.0500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":115.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":281.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":227.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":75.5200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":100.6900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":92.2000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":198.3500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":100.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":154.0600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":154.0600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":76.5100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":145.8700,"methodology":"fee schedule"}]}]},{"description":"Removal of Gallbladder Using Laparoscope","code_information":[ { "code": "47562", "type": "CPT" } ],"standard_charges":[{"minimum":168.0000,"maximum":350.0000,"gross_charge":350.0000,"discounted_cash":350.0000,"setting":"outpatient","payers_information":[{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":223.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":297.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":326.5200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":224.4000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":331.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":318.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":297.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":350.0000,"methodology":"fee schedule"}]}]},{"description":"Screening Mammogram","code_information":[ { "code": "77067", "type": "CPT" } ],"standard_charges":[{"minimum":16.2500,"maximum":121.8200,"gross_charge":245.0000,"discounted_cash":245.0000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":38.9800,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":16.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":73.9100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":73.9100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":69.5700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":97.4200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":49.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":46.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":31.9900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":100.7600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":66.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":47.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":33.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":37.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":102.2200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":46.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":57.1800,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":121.8200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":63.5200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":59.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":82.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":55.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":102.2200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":102.2200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":102.2200,"methodology":"fee schedule"}]}]},{"description":"Ultrasound of Non-Pregnant Uterus","code_information":[ { "code": "76830", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":150.0000,"gross_charge":168.9800,"discounted_cash":168.9800,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":35.7300,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":65.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":56.2300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":93.5500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":32.8600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":62.9500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":65.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":42.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":41.3100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":55.1700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":44.0800,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":51.1100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":53.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":59.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":90.2600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":90.2600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":35.7300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":90.5700,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Lower Back, Minimum of 4 Views","code_information":[ { "code": "72110", "type": "CPT" } ],"standard_charges":[{"minimum":11.5000,"maximum":43.7700,"gross_charge":147.6700,"discounted_cash":147.6700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":14.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.2400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":23.4900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":39.0300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":25.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":15.3600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":24.9100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":31.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.8400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":16.4000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.7000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":43.7700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":17.4800,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.1700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":22.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":36.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":25.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":33.7100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":33.7100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.2400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":36.0100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Chest, 1 View","code_information":[ { "code": "71045", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":24.8900,"gross_charge":84.7200,"discounted_cash":84.7200,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.3800,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.2300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.3300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.9600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":7.0800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":11.5400,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.8900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":7.0900,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":21.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.8700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":10.8700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.3800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.7300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Glucose Level in Blood Using Strip","code_information":[ { "code": "82948", "type": "CPT" } ],"standard_charges":[{"minimum":1.7700,"maximum":8.0000,"gross_charge":12.6100,"discounted_cash":12.6100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":4.6200,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.0300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.2800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":4.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":1.7700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":4.4300,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":4.3200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":4.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":4.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Blood Typing for Group and Rh Status","code_information":[ { "code": "86900", "type": "CPT" } ],"standard_charges":[{"minimum":2.0000,"maximum":15.0000,"gross_charge":21.4200,"discounted_cash":21.4200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.6000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":3.6900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":2.9900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":2.8500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":3.6900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":7.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":5.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":2.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":2.9900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":4.0700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.4200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":2.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.0300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":3.6900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":2.9900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Blood Typing for Group and Rh Status","code_information":[ { "code": "86901", "type": "CPT" } ],"standard_charges":[{"minimum":2.0000,"maximum":15.0000,"gross_charge":21.4200,"discounted_cash":21.4200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.6000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":3.6900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":2.9900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":2.8500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":3.6900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":7.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":5.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":2.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":2.9900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":4.0700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.4200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":2.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.0300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":3.6900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":2.9900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"}]}]},{"description":"Ultrasound of Breast","code_information":[ { "code": "76641", "type": "CPT" } ],"standard_charges":[{"minimum":15.0000,"maximum":150.0000,"gross_charge":89.2500,"discounted_cash":89.2500,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":37.5300,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":63.2700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":73.5000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":53.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":33.8400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":72.3900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":36.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":87.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":23.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":35.7300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":36.3600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":50.8600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":38.7500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":41.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":48.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":36.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":33.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":73.2200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":73.2200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":37.5300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":72.3900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Chest, 2 Views","code_information":[ { "code": "71046", "type": "CPT" } ],"standard_charges":[{"minimum":6.5000,"maximum":56.7200,"gross_charge":88.0600,"discounted_cash":88.0600,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.1900,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.1200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.5600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":19.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":7.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":16.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":14.6700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.8900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.1000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":56.7200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.8900,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":26.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.1900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":22.1800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Hemoglobin A1c Level","code_information":[ { "code": "83036", "type": "CPT" } ],"standard_charges":[{"minimum":8.8300,"maximum":30.0000,"gross_charge":22.4900,"discounted_cash":22.4900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.9900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":29.9300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.7100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.2500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.9900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.3000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.7100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":8.8300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":10.5500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":13.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":12.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.9300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":15.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":13.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.7900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":11.9900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.7100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Magnesium Level","code_information":[ { "code": "83735", "type": "CPT" } ],"standard_charges":[{"minimum":6.0900,"maximum":24.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":9.3600,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":9.1800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.8900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.7000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.3800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.2800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":9.3600,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":9.1400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.4400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.7000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Phosphate Level","code_information":[ { "code": "84100", "type": "CPT" } ],"standard_charges":[{"minimum":4.1300,"maximum":16.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.8500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":8.5500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.7400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.5200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":5.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.7400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.1300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.1500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.4600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.5200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.9000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.2700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":5.8500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.7400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Lipase Enzyme Level","code_information":[ { "code": "83690", "type": "CPT" } ],"standard_charges":[{"minimum":5.7600,"maximum":20.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":8.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.6600,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.5100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.3000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.5700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":8.5100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":5.7600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.4900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":8.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":9.3800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.5700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.6500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":8.5100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Amylase Enzyme Level","code_information":[ { "code": "82150", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":16.0000,"gross_charge":304.0400,"discounted_cash":304.0400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":10.3100,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":10.1600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":10.3200,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.0700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":6.8700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.5700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.3100,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.4000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.0300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":9.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - LDH Enzyme Level","code_information":[ { "code": "83615", "type": "CPT" } ],"standard_charges":[{"minimum":4.6600,"maximum":28.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.1400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.4200,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.4500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.7300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.0400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":5.7500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":7.4500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.1100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.0400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":6.5600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":8.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":5.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.8900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":6.7100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":7.4500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.0400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of C-Reactive Protein Levels","code_information":[ { "code": "86140", "type": "CPT" } ],"standard_charges":[{"minimum":3.6600,"maximum":20.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":4.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":6.4200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.1400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.4200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":3.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin D-3 Level","code_information":[ { "code": "82306", "type": "CPT" } ],"standard_charges":[{"minimum":26.9100,"maximum":120.0000,"gross_charge":357.0000,"discounted_cash":357.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":36.5500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":106.5700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":28.2300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":36.5500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":115.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":68.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":72.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":26.9100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":32.1600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":40.3300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":28.2300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":53.7000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":34.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":60.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":48.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":32.8900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":36.5500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":40.6100,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Abdomen and Pelvis Without Contrast","code_information":[ { "code": "74176", "type": "CPT" } ],"standard_charges":[{"minimum":63.5900,"maximum":450.0000,"gross_charge":937.1200,"discounted_cash":937.1200,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":279.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":102.2700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":115.7100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":63.5900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":102.6400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":309.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":67.9100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":97.0100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":71.8900,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":98.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":272.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":116.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":116.0000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":114.9500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Sedimentation Rate","code_information":[ { "code": "85651", "type": "CPT" } ],"standard_charges":[{"minimum":3.2300,"maximum":8.5500,"gross_charge":23.2000,"discounted_cash":23.2000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":4.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":8.5500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.2700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.3800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.2700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.2300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.3000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":4.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":4.8300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":3.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.0400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.2700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.2700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Free Thyroxine Level","code_information":[ { "code": "84439", "type": "CPT" } ],"standard_charges":[{"minimum":8.1900,"maximum":41.8300,"gross_charge":35.3400,"discounted_cash":35.3400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":19.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":19.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.1300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.8300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.8200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":21.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":8.1900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":19.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":12.2800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":8.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.4600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":18.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.0200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":11.1300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Pregnancy Hormone Identification","code_information":[ { "code": "84703", "type": "CPT" } ],"standard_charges":[{"minimum":6.8400,"maximum":49.0000,"gross_charge":116.6200,"discounted_cash":116.6200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.2900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":25.4700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.5200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":7.1700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":9.2900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.3200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.5200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":6.8400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.1700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":10.2400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":7.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.8800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":11.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.3600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":9.2900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.5200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Measurement of Bone Density Using Dual-Energy X-Rays of Hips, Pelvis, And\/or Spine","code_information":[ { "code": "77080", "type": "CPT" } ],"standard_charges":[{"minimum":10.4400,"maximum":90.0000,"gross_charge":125.0000,"discounted_cash":125.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":10.4400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":30.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":56.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.8900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":65.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":42.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":47.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":38.2100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":29.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":13.9300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.1000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":21.8100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":15.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":29.1800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":20.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":72.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":53.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":32.6200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":32.6200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Direct Bilirubin Level","code_information":[ { "code": "82248", "type": "CPT" } ],"standard_charges":[{"minimum":4.5600,"maximum":10.5900,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":8.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.1900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.5900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.0200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.7800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.1900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.5600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.4500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.8300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.5700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.0200,"methodology":"fee schedule"}]}]},{"description":"Ultrasound of Soft Tissue of Head and Neck","code_information":[ { "code": "76536", "type": "CPT" } ],"standard_charges":[{"minimum":15.0000,"maximum":150.0000,"gross_charge":225.1400,"discounted_cash":225.1400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":28.8700,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":45.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":42.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":42.7600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":91.7900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":33.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":24.3800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":60.0700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":44.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":39.2800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":50.7700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":42.0700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":37.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":48.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":43.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":91.3500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":91.3500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":28.8700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":89.8500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Chest Without Contrast","code_information":[ { "code": "71250", "type": "CPT" } ],"standard_charges":[{"minimum":43.9300,"maximum":450.0000,"gross_charge":711.9700,"discounted_cash":711.9700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":59.9100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":195.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":119.4800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":93.5500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":43.9300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":83.3500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":57.4300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":71.4700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":66.7100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":107.5600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":73.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":106.9400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":106.9400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":59.9100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":102.2200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Lower Back, 2-3 Views","code_information":[ { "code": "72100", "type": "CPT" } ],"standard_charges":[{"minimum":8.5000,"maximum":31.4000,"gross_charge":98.7700,"discounted_cash":98.7700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":21.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":21.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.0900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":29.5400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":18.7000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":18.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.2400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":17.9000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":21.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":11.7600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":17.2900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":31.4000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":12.5400,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.6100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":27.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":27.2800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Quantitative D-Dimer Test","code_information":[ { "code": "85379", "type": "CPT" } ],"standard_charges":[{"minimum":9.7100,"maximum":20.0000,"gross_charge":135.0000,"discounted_cash":135.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":14.4800,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":12.5600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":10.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.7100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":12.5600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":14.0400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":10.1800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.7100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":11.0600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.2200,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":13.8700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":9.7100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":11.3100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":12.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":10.1800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":13.8500,"methodology":"fee schedule"}]}]},{"description":"Multiple SPECT Scans of Heart Muscle","code_information":[ { "code": "78452", "type": "CPT" } ],"standard_charges":[{"minimum":105.3000,"maximum":1000.0000,"gross_charge":2059.4000,"discounted_cash":2059.4000,"setting":"outpatient","payers_information":[{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":355.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":375.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":381.6700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":297.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":355.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":105.3000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":251.6500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":123.6800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":208.4500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":208.4500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":271.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":403.4200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":355.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":1000.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":301.7500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":564.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":412.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":322.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":350.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":710.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":422.2900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":407.0200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Knee, 1 or 2 Views","code_information":[ { "code": "73560", "type": "CPT" } ],"standard_charges":[{"minimum":6.7500,"maximum":27.4000,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.9000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.7200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.0600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.3700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.6800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":27.4000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.1500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":21.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":25.4600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Identification of Hidden Blood in Stool Sample Using Chemical Reagent for Colon Cancer Screening","code_information":[ { "code": "82270", "type": "CPT" } ],"standard_charges":[{"minimum":2.6900,"maximum":20.8000,"gross_charge":23.2000,"discounted_cash":23.2000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":4.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.1700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.1000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":2.6900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":4.4300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":3.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":4.8300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":4.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":4.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.3800,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Abdomen and Pelvis With and Without Contrast","code_information":[ { "code": "74178", "type": "CPT" } ],"standard_charges":[{"minimum":68.7500,"maximum":450.0000,"gross_charge":954.9700,"discounted_cash":954.9700,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":102.8600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":279.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":183.8900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":284.1800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":94.4200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":180.7100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":320.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":204.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":189.2000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":117.8100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":161.7000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":125.0300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":156.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":272.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":102.8600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":273.1900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Neck, 2 or 3 Views","code_information":[ { "code": "72040", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":29.5500,"gross_charge":88.0600,"discounted_cash":88.0600,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":19.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.6200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":29.1900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":17.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.9900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":11.1200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":17.0600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":29.5500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.9100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.5700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":25.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":17.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.4700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":27.2800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin B-12 Level","code_information":[ { "code": "82607", "type": "CPT" } ],"standard_charges":[{"minimum":13.7100,"maximum":49.3300,"gross_charge":93.2900,"discounted_cash":93.2900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":21.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":20.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.9900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":18.6100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":49.3300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":15.0800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":14.3800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.6100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":26.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":15.0800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":13.7100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.3800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":21.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":20.5400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":14.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":17.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":18.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":16.7500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":18.6100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":15.0800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.6800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Ferritin Level","code_information":[ { "code": "82728", "type": "CPT" } ],"standard_charges":[{"minimum":12.3400,"maximum":43.5300,"gross_charge":93.2900,"discounted_cash":93.2900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":18.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.9900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":43.5300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.6300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.6300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.3400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.8100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":18.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":18.5700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.7600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":16.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.1500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":16.8300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.6300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Identification of Hidden Blood in Stool Using Immunoassay","code_information":[ { "code": "82274", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":48.0000,"gross_charge":54.0000,"discounted_cash":54.0000,"setting":"outpatient","payers_information":[{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":15.1700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":22.5300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":22.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":18.0800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.7400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":15.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":20.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":21.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":21.7000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - PKU Test","code_information":[ { "code": "84030", "type": "CPT" } ],"standard_charges":[{"minimum":5.0000,"maximum":97.5000,"gross_charge":126.0000,"discounted_cash":126.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":12.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":12.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":11.6600,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.7900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":37.0800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.7900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":97.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.9800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":12.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":7.4900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.9400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":11.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":9.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":6.1100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.7900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":96.0000,"methodology":"fee schedule"}]}]},{"description":"Complete Ultrasound of Kidneys, Aorta, and Lymph Nodes","code_information":[ { "code": "76770", "type": "CPT" } ],"standard_charges":[{"minimum":22.7500,"maximum":150.0000,"gross_charge":317.7300,"discounted_cash":317.7300,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":37.8900,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":22.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":65.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":66.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":48.4900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":79.4800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":30.8500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":58.4100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":71.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":38.3700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":51.9100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":40.9100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":22.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":44.2900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":51.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":57.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":79.0200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":79.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":37.8900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":78.2100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Creatinine Level in Sample Other Than Blood","code_information":[ { "code": "82570", "type": "CPT" } ],"standard_charges":[{"minimum":4.5100,"maximum":12.7300,"gross_charge":46.8800,"discounted_cash":46.8800,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.3900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.7300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.1800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.8800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.3900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.1800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.6300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.7100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":4.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.7500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.3900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.1800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":7.1000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Shoulder, 2 or More Views","code_information":[ { "code": "73030", "type": "CPT" } ],"standard_charges":[{"minimum":7.2500,"maximum":25.9700,"gross_charge":88.0600,"discounted_cash":88.0600,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":19.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":25.6700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":19.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.7700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.6700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":25.9700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.5100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.7100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.2900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":20.2900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"}]}]},{"description":"MRI of Both Breasts With and Without Contrast","code_information":[ { "code": "77049", "type": "CPT" } ],"standard_charges":[{"minimum":117.6500,"maximum":800.0000,"gross_charge":1762.3900,"discounted_cash":1762.3900,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":117.6500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":513.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":206.3500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":284.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":144.5200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":288.4700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":618.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":412.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":206.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":231.1000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":132.5400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":170.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":276.2500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":217.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":375.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":176.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":513.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":347.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":295.0400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":117.6500,"methodology":"fee schedule"}]}]},{"description":"Complete Ultrasound of Female Pelvis Unrelated to Pregnancy","code_information":[ { "code": "76856", "type": "CPT" } ],"standard_charges":[{"minimum":18.7500,"maximum":150.0000,"gross_charge":168.9800,"discounted_cash":168.9800,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":24.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":35.3700,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":18.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":53.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":46.4100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":78.7800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":41.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":29.7800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":58.7900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":49.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":37.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":50.1600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":39.7700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":18.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":40.8800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":49.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":47.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":78.3000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":78.3000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":35.3700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":77.1100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Glucose Level in Blood","code_information":[ { "code": "82947", "type": "CPT" } ],"standard_charges":[{"minimum":4.4700,"maximum":16.0000,"gross_charge":23.2000,"discounted_cash":23.2000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.9400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.3600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.6000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.3600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.9600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":5.3600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":6.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.3600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.4700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.8800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":5.3600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":5.2600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.1000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.3600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":5.3600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.3600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clot Activity","code_information":[ { "code": "85384", "type": "CPT" } ],"standard_charges":[{"minimum":7.7200,"maximum":38.4900,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":38.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":31.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":10.4900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.2600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":10.4900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":7.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.9100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":38.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":11.5700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":8.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":16.0900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":23.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":9.7200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":10.4900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.7200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Pregnancy Hormone Level","code_information":[ { "code": "84702", "type": "CPT" } ],"standard_charges":[{"minimum":14.3600,"maximum":58.8300,"gross_charge":116.6200,"discounted_cash":116.6200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":28.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":20.5400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":58.8300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":20.5400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":14.3600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":20.5400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":26.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":23.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":20.5400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":17.1100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":18.6800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":20.5400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":14.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":24.0400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":27.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":22.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.5400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":20.5400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":20.5400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.5400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Abdomen, 1 View","code_information":[ { "code": "74018", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":23.3300,"gross_charge":69.6100,"discounted_cash":69.6100,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.3800,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.4900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.4500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.4100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":12.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.3900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":21.3600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":18.4800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":18.4800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.3800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.3600,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Foot, 3 or More Views","code_information":[ { "code": "73630", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":26.7200,"gross_charge":88.0600,"discounted_cash":88.0600,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":18.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":15.8000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.7200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":17.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.6900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.7900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.4800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":25.9200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.5200,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.6300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.3800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":21.3800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.7300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Creatinine Level in Blood Sample","code_information":[ { "code": "82565", "type": "CPT" } ],"standard_charges":[{"minimum":4.6600,"maximum":10.4500,"gross_charge":107.1000,"discounted_cash":107.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":8.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.4500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.8900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.3300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.5700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.9800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.1700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":7.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.6900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.3300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":7.0300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Potassium Level","code_information":[ { "code": "84132", "type": "CPT" } ],"standard_charges":[{"minimum":4.1100,"maximum":16.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.6800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":8.8300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.7600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":5.8600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.7600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.1100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.0800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.2600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.2900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":7.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.1100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":5.6800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.7600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Hemoglobin Blood Count","code_information":[ { "code": "85018", "type": "CPT" } ],"standard_charges":[{"minimum":1.7800,"maximum":6.6500,"gross_charge":12.6100,"discounted_cash":12.6100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":5.7800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.3700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":2.9300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":6.6500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":2.3700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":2.0300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":2.9300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":4.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":2.3700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":1.9200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":3.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":1.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":2.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":4.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":2.6300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":2.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":2.3700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":3.2300,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Neck Spine Without Contrast","code_information":[ { "code": "72125", "type": "CPT" } ],"standard_charges":[{"minimum":50.2500,"maximum":450.0000,"gross_charge":711.9700,"discounted_cash":711.9700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":54.8600,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":218.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":120.5100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":94.6100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":50.2500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":94.4200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":58.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":70.5600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":68.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":108.3300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":74.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":54.8600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":107.6700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Red Blood Cell Volume","code_information":[ { "code": "85014", "type": "CPT" } ],"standard_charges":[{"minimum":2.0700,"maximum":7.0000,"gross_charge":12.6100,"discounted_cash":12.6100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":6.2800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.3700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":2.9300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":6.3700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":2.3700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":2.2600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":2.9300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":5.9000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":2.3700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":3.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":2.2600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":2.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":4.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":2.6300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":2.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":2.3700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":3.2300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Urea Nitrogen Level in Blood","code_information":[ { "code": "84520", "type": "CPT" } ],"standard_charges":[{"minimum":3.5900,"maximum":16.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.8800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":6.9300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.9500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":4.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":6.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.9500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.5900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.2900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.8300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.3900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.8800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.9500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"MRI of Brain Without Contrast","code_information":[ { "code": "70551", "type": "CPT" } ],"standard_charges":[{"minimum":71.0200,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":193.3700,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":76.1500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":239.0200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":149.4700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":71.0200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":151.6800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":281.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":227.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":77.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":102.5600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":94.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":198.2500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":102.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":160.5900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":160.5900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":76.1500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":151.6800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Platelet Count","code_information":[ { "code": "85049", "type": "CPT" } ],"standard_charges":[{"minimum":3.0000,"maximum":8.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":4.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.2700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":4.9700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.1400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.9700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.9500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":6.2500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.1000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.2700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.7000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":4.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.9700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":5.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.9700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":6.0900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Sacroiliac Joints, 1-2 Views","code_information":[ { "code": "72200", "type": "CPT" } ],"standard_charges":[{"minimum":4.2000,"maximum":21.6000,"gross_charge":108.6400,"discounted_cash":108.6400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":15.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":15.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.2700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.8600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":14.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.2600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.4600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.4900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.6500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":16.6300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.1300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.5900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":21.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":14.4700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":14.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.3400,"methodology":"fee schedule"}]}]},{"description":"Complete Ultrasound of Joint","code_information":[ { "code": "76881", "type": "CPT" } ],"standard_charges":[{"minimum":19.0000,"maximum":150.0000,"gross_charge":130.0000,"discounted_cash":130.0000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":32.4800,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":53.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":57.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":45.4500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":36.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":71.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":31.3600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":52.2700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":74.5700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":49.7100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":49.7100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":49.7100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":36.8800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":37.4300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":36.6100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":41.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":60.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":43.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":72.1300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":72.1300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":32.4800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":47.2800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Knee, 3 Views","code_information":[ { "code": "73562", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":32.0000,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":18.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.7400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":17.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.4000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.2700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":11.9600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":17.1300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":31.8000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":12.8000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.5600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":16.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.8200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":26.8200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":30.1900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Foot, 2 Views","code_information":[ { "code": "73620", "type": "CPT" } ],"standard_charges":[{"minimum":6.5000,"maximum":23.1000,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.9400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.9900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.4500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.4300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":13.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":8.7300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.3900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":23.1000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":9.3700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.3500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":18.8400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":18.8400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.9400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.3600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Iron Level","code_information":[ { "code": "83540", "type": "CPT" } ],"standard_charges":[{"minimum":5.1700,"maximum":16.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.9900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":7.9900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.4100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":5.1700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.0300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":8.8200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.1400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":7.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":7.9900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Chest With Contrast","code_information":[ { "code": "71260", "type": "CPT" } ],"standard_charges":[{"minimum":50.3900,"maximum":450.0000,"gross_charge":805.2700,"discounted_cash":805.2700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":63.8800,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":141.3100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":128.3700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":50.3900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":100.5500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":142.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":151.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":122.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":71.0600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":85.9800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":80.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":117.7200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":88.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":137.3900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":137.3900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":63.8800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":136.4100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Thyroxine Level","code_information":[ { "code": "84436", "type": "CPT" } ],"standard_charges":[{"minimum":6.2400,"maximum":24.0000,"gross_charge":58.1900,"discounted_cash":58.1900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.4800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.8700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":8.4800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.6800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.3500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.8700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":6.2400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.4600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":9.3500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.9200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":8.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.6300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":8.4800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.8700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - FSH Hormone Level","code_information":[ { "code": "83001", "type": "CPT" } ],"standard_charges":[{"minimum":16.8900,"maximum":76.0000,"gross_charge":28.9100,"discounted_cash":28.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":22.9400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":60.8300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":17.7200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":22.9400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":27.1600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":25.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":16.8900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":20.1900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":25.3100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":17.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":27.3100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":21.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":27.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":24.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.6500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.9400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":76.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Testosterone Level","code_information":[ { "code": "84403", "type": "CPT" } ],"standard_charges":[{"minimum":23.4700,"maximum":83.6700,"gross_charge":48.1900,"discounted_cash":48.1900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":37.6400,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":37.3200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":35.0900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":31.8700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":83.6700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":25.8100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":37.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":24.6200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":31.8700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":54.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":25.8100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":23.4700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":28.0400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":37.6400,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":35.1700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":24.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":40.9900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":30.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":32.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":28.6800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":31.8700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":25.8100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":56.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Uric Acid Level","code_information":[ { "code": "84550", "type": "CPT" } ],"standard_charges":[{"minimum":4.1100,"maximum":12.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.5800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":6.6500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.5200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.3100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":5.5800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.1600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.5200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.1100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.9100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.1600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.2400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.0200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":5.5800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.5200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Free T3 Thyroid Hormone Level","code_information":[ { "code": "84481", "type": "CPT" } ],"standard_charges":[{"minimum":15.4000,"maximum":115.0000,"gross_charge":160.6500,"discounted_cash":160.6500,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":48.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":48.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.6600,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":20.9200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":97.1700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.9400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":16.1500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":20.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":115.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":16.9400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":18.4100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":48.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":23.0700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":16.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":36.1300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":45.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":33.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":18.8200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":20.9200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.9400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":44.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Immature Red Blood Cell Count","code_information":[ { "code": "85045", "type": "CPT" } ],"standard_charges":[{"minimum":3.6300,"maximum":10.0000,"gross_charge":12.0000,"discounted_cash":12.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0600,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.9300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.6000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.8200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":5.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.4500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.6300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":5.4500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.7400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.4400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":5.4400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Hand, 2 Views","code_information":[ { "code": "73120", "type": "CPT" } ],"standard_charges":[{"minimum":6.5000,"maximum":23.5600,"gross_charge":65.5600,"discounted_cash":65.5600,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.3500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.5600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.8700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.4700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.1600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.5500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":23.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.1300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.4600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.2900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":20.2900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":22.1800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Pelvis, 1-2 Views","code_information":[ { "code": "72170", "type": "CPT" } ],"standard_charges":[{"minimum":5.2500,"maximum":28.3700,"gross_charge":63.6600,"discounted_cash":63.6600,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.6900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":7.8000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.2800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.6700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.7100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":28.3700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.4000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.4400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":21.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":12.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.5600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":23.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Folic Acid Level","code_information":[ { "code": "82746", "type": "CPT" } ],"standard_charges":[{"minimum":9.3300,"maximum":48.7500,"gross_charge":93.2900,"discounted_cash":93.2900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":13.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":18.1500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":48.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.7000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.0200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.1500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":14.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.4800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.9700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":20.0300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":14.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":23.0300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":13.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":16.3400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":18.1500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.7000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Hand, 3 or More Views","code_information":[ { "code": "73130", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":28.4800,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":18.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.9300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":28.4800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":17.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.1300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.2800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.5100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.3900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":27.4500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.4000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.2400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.5600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":23.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":26.5500,"methodology":"fee schedule"}]}]},{"description":"MRI of Upper Spinal Canal Without Contrast","code_information":[ { "code": "72141", "type": "CPT" } ],"standard_charges":[{"minimum":69.1200,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":193.3700,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":76.5100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":238.0500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":69.1200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":115.9100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":75.6300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":100.6000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":317.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":92.2000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":199.6000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":100.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":154.0600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":154.0600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":76.5100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":145.5100,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels in Chest With Contrast","code_information":[ { "code": "71275", "type": "CPT" } ],"standard_charges":[{"minimum":80.6000,"maximum":450.0000,"gross_charge":676.7000,"discounted_cash":676.7000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":93.4700,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":148.3500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":180.0700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":243.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":80.6000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":153.5500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":247.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":148.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":100.8400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":129.4700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":122.9000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":130.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":213.8700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":213.8700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":93.4700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":183.7000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Large Intestine Without Contrast","code_information":[ { "code": "74261", "type": "CPT" } ],"standard_charges":[{"minimum":74.4300,"maximum":450.0000,"gross_charge":300.0000,"discounted_cash":300.0000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":123.4300,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":118.5100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":118.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":74.4300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":248.9700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":269.6700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":179.7800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":164.7000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":113.9400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":109.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":117.5200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":118.2500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":160.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":95.4300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":120.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":178.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":123.1200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":123.1200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":123.4300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":122.9100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Thyroid Hormone Uptake Analysis","code_information":[ { "code": "84479", "type": "CPT" } ],"standard_charges":[{"minimum":5.8800,"maximum":24.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.9800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":7.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.4100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":5.8800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.0300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.6400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":8.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.1800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":7.9800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Single Hip, 2-3 Views","code_information":[ { "code": "73502", "type": "CPT" } ],"standard_charges":[{"minimum":8.0000,"maximum":36.9300,"gross_charge":88.0600,"discounted_cash":88.0600,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":23.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":23.2500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":21.9200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":36.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":13.5600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":21.1600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":14.8300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":36.9300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":14.8300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":24.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":18.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":30.8100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":30.8100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":34.5500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Mid Back, 2 Views","code_information":[ { "code": "72070", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":30.4800,"gross_charge":98.7700,"discounted_cash":98.7700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":21.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.2000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.2100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":18.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.1100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":17.3600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":19.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":11.4100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.3800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":30.4800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":12.1600,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.6100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":26.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":21.8200,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Facial Bones Without Contrast","code_information":[ { "code": "70486", "type": "CPT" } ],"standard_charges":[{"minimum":43.7300,"maximum":450.0000,"gross_charge":703.4000,"discounted_cash":703.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":44.0300,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":183.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":116.1700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":99.5300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":43.7300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":71.2600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":62.7200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":57.0300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":109.8500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":62.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":98.6000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":98.6000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":44.0300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":98.2100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Lower Leg","code_information":[ { "code": "73590", "type": "CPT" } ],"standard_charges":[{"minimum":6.7500,"maximum":27.5000,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.3000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.4100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.2600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":27.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.2500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.6000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.6000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.2600,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.4300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":21.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.6600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":20.6600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.3000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":22.9100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ankle, 2 Views","code_information":[ { "code": "73600", "type": "CPT" } ],"standard_charges":[{"minimum":6.5000,"maximum":26.4800,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.6500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.9600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.6100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.1900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.9600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.0100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":26.4800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.6400,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.6400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.7400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":21.7400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":23.6400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Both Hips, 2 Views","code_information":[ { "code": "73521", "type": "CPT" } ],"standard_charges":[{"minimum":9.0000,"maximum":35.3900,"gross_charge":170.2000,"discounted_cash":170.2000,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":19.5700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":30.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":12.3800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":19.7100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":14.1200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":13.4300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":17.9400,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":35.3900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.4300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":20.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.8200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":26.8200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":29.1000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Lower Spine Without Contrast","code_information":[ { "code": "72131", "type": "CPT" } ],"standard_charges":[{"minimum":49.5600,"maximum":450.0000,"gross_charge":711.9700,"discounted_cash":711.9700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":51.6100,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":183.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":119.9700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":93.9000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":49.5600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":92.0800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":57.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":69.7000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":66.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":107.3900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":72.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":51.6100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":106.9500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Protein Level in Urine","code_information":[ { "code": "84156", "type": "CPT" } ],"standard_charges":[{"minimum":3.3400,"maximum":30.0000,"gross_charge":15.0000,"discounted_cash":15.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":6.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":14.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.5300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":4.5300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.6700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.3400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.6300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.0700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.6700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ankle, 3 or More Views","code_information":[ { "code": "73610", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":28.8300,"gross_charge":98.7700,"discounted_cash":98.7700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":18.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.9300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":28.8300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":17.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.3400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.9800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.5500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.4200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":28.0700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.2700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.9100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":26.5500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Stool Culture for Bacteria","code_information":[ { "code": "87045", "type": "CPT" } ],"standard_charges":[{"minimum":6.4500,"maximum":28.3300,"gross_charge":81.5100,"discounted_cash":81.5100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":12.5600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":15.5900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.6600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":27.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.4400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":10.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":12.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.6700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":28.3300,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.4400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":6.4500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":10.2600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":19.7300,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":12.8600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.6700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.0500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.4900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":11.6600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.4400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.5700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Stool Culture for Bacteria","code_information":[ { "code": "87046", "type": "CPT" } ],"standard_charges":[{"minimum":6.4500,"maximum":28.3300,"gross_charge":81.5100,"discounted_cash":81.5100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":12.5600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":15.5900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.6600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":27.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.4400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":10.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":12.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.6700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":28.3300,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.4400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":6.4500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":10.2600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":19.7300,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":12.8600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.6700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.0500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.4900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":11.6600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.4400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.5700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - SGOT Enzyme Level","code_information":[ { "code": "84450", "type": "CPT" } ],"standard_charges":[{"minimum":4.7100,"maximum":12.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.3900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.4500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.1800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.9400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.3900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.1800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.7100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.6300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.7100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.7500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.3900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.1800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Calcium Level in Blood","code_information":[ { "code": "82310", "type": "CPT" } ],"standard_charges":[{"minimum":4.2600,"maximum":27.4000,"gross_charge":15.0000,"discounted_cash":15.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.0400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.7100,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.3700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":27.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.1600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.9200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.3700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.5200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":7.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.1600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.2600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.6100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":7.0700,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":7.0300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.9200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.9500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.7300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.3700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.1600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":7.0800,"methodology":"fee schedule"}]}]},{"description":"Nuclear Medicine Study of Bones And\/or Joints With Delayed Images in 3 Phases","code_information":[ { "code": "78315", "type": "CPT" } ],"standard_charges":[{"minimum":77.6800,"maximum":316.4500,"gross_charge":833.8300,"discounted_cash":833.8300,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":100.4500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":133.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":99.3400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":183.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":97.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":204.0900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":303.0900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":266.6600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":109.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":77.6800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":310.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":156.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":316.4500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":316.4500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":308.4500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Elbow , 2 Views","code_information":[ { "code": "73070", "type": "CPT" } ],"standard_charges":[{"minimum":6.5000,"maximum":24.2800,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.3000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.9900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.4500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":14.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.6700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":13.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.1200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.8600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.5500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":13.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.5700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":19.5700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.3000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.3600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Parathyroid Hormone Level","code_information":[ { "code": "83970", "type": "CPT" } ],"standard_charges":[{"minimum":37.5200,"maximum":130.0000,"gross_charge":340.3400,"discounted_cash":340.3400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":87.8600,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":50.9600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":60.1700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":41.2800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":39.3600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":41.2800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":104.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":41.2800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":37.5200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":44.8500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":56.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":39.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":69.2100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":48.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":67.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":45.8600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":50.9600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":41.2800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":120.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - LH Hormone Level","code_information":[ { "code": "83002", "type": "CPT" } ],"standard_charges":[{"minimum":16.8300,"maximum":40.0000,"gross_charge":28.9100,"discounted_cash":28.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":22.8600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":37.1500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":18.5200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":17.6500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":22.8600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":33.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":18.5200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":16.8300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":20.1200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":25.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":17.6500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":27.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":21.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":22.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.5700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.8600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":18.5200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Wrist, 2 Views","code_information":[ { "code": "73100", "type": "CPT" } ],"standard_charges":[{"minimum":6.5000,"maximum":26.3700,"gross_charge":98.7700,"discounted_cash":98.7700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.8400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.3700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":7.6500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.1600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.6300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":25.8600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.2700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.7300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Upper Leg, 2 or More Views","code_information":[ { "code": "73552", "type": "CPT" } ],"standard_charges":[{"minimum":7.2500,"maximum":45.3600,"gross_charge":88.0600,"discounted_cash":88.0600,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.3800,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":21.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":21.7500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":17.0300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":27.0700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":45.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.4700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.8200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":11.7800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.3400,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":29.0400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.7800,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.9200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":23.9200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.3800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":25.8200,"methodology":"fee schedule"}]}]},{"description":"Ultrasound of Scrotum","code_information":[ { "code": "76870", "type": "CPT" } ],"standard_charges":[{"minimum":20.5000,"maximum":150.0000,"gross_charge":165.5200,"discounted_cash":165.5200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":32.8400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":20.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":56.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":51.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":45.6800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":76.3200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":45.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":28.3000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":34.8600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":34.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":36.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":23.1500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":44.1500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":41.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":41.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":24.4200,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":20.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":38.0900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":46.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":65.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":49.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":36.9700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":36.9700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":32.8400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":74.9300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Entire Back for Scoliosis Evaluation, 2-3 Views","code_information":[ { "code": "72082", "type": "CPT" } ],"standard_charges":[{"minimum":10.0000,"maximum":56.2700,"gross_charge":98.7700,"discounted_cash":98.7700,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.6000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":43.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":33.1600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":56.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":24.1600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":31.8400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":39.8600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":23.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":23.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":21.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":22.3000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":29.5600,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":55.4400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":43.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":27.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":43.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":33.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":47.1200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":47.1200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.6000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":52.3800,"methodology":"fee schedule"}]}]},{"description":"MRI of Leg Not Including Joint Without Contrast","code_information":[ { "code": "73718", "type": "CPT" } ],"standard_charges":[{"minimum":69.2900,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":69.2900,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":245.1300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":192.0300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":90.5100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":157.4500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":281.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":227.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":109.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":117.2800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":121.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":196.8500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":112.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":368.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":245.4200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":245.4200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":69.2900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Chest With and Without Contrast","code_information":[ { "code": "71270", "type": "CPT" } ],"standard_charges":[{"minimum":71.1000,"maximum":650.0000,"gross_charge":954.9700,"discounted_cash":954.9700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":71.1000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":155.2400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":158.9700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":78.0100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":120.4600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":155.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":85.0300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":100.8500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":96.4100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":129.1900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":102.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":170.0100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":170.0100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":71.1000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":166.6100,"methodology":"fee schedule"}]}]},{"description":"MRI of Pelvis With Contrast","code_information":[ { "code": "72196", "type": "CPT" } ],"standard_charges":[{"minimum":89.1400,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":193.3700,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":89.1400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":254.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":226.1400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":109.6700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":178.2200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":310.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":232.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":126.1100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":140.7400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":142.6300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":217.5500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":137.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":267.5200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":267.5200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":89.1400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":228.4400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Lower Arm","code_information":[ { "code": "73090", "type": "CPT" } ],"standard_charges":[{"minimum":6.7500,"maximum":23.1000,"gross_charge":88.0600,"discounted_cash":88.0600,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.1700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.8000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.5700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":13.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.5200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.3500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":8.6700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.8100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":23.1000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":9.2500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.4100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":21.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":17.7600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":17.7600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.7300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Prolactin Hormone Level","code_information":[ { "code": "84146", "type": "CPT" } ],"standard_charges":[{"minimum":17.6100,"maximum":68.8300,"gross_charge":32.1300,"discounted_cash":32.1300,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":37.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":23.9200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":68.8300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.3800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":18.4800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":23.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":19.3800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":17.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.0500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":26.4000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":18.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":30.1700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":22.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.5300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":23.9200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.3800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"MRI of Pelvis With and Without Contrast","code_information":[ { "code": "72197", "type": "CPT" } ],"standard_charges":[{"minimum":112.9600,"maximum":1300.0000,"gross_charge":1502.6000,"discounted_cash":1502.6000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":112.9600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":306.8400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":283.4700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":136.4500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":218.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":431.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":335.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":290.6300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":155.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":176.1900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":174.7700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":239.8200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":173.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":324.0800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":324.0800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":112.9600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":287.0100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Upper Arm","code_information":[ { "code": "73060", "type": "CPT" } ],"standard_charges":[{"minimum":7.2500,"maximum":25.8600,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":17.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.6100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.4200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.8100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":25.8600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.3900,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.7200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.0200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":21.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":23.2700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Free Testosterone Level","code_information":[ { "code": "84402", "type": "CPT" } ],"standard_charges":[{"minimum":23.1600,"maximum":170.0000,"gross_charge":214.2000,"discounted_cash":214.2000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":63.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":61.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":54.9900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":31.4500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":73.7300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":25.4700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":31.4500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":68.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":68.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":170.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":25.4700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":23.1600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":27.6700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":63.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":34.6900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":48.2400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":29.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":59.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":45.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":28.3000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":31.4500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":25.4700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"}]}]},{"description":"MRI of Abdomen With Contrast","code_information":[ { "code": "74182", "type": "CPT" } ],"standard_charges":[{"minimum":89.1400,"maximum":800.0000,"gross_charge":1788.0900,"discounted_cash":1788.0900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":89.1400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":261.5700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":266.9400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":122.1800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":196.3500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":335.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":271.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":139.1200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":155.1300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":157.1300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":217.5500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":151.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":303.7800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":303.7800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":89.1400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":270.6400,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels of Abdomen and Pelvis With Contrast","code_information":[ { "code": "74174", "type": "CPT" } ],"standard_charges":[{"minimum":111.8700,"maximum":450.0000,"gross_charge":954.9700,"discounted_cash":954.9700,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":111.8700,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":202.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":313.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":243.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":124.4100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":198.6200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":302.3700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":201.5800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":143.5300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":143.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":124.9100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":175.6000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":191.2500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":128.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":172.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":240.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":111.8700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":301.9200,"methodology":"fee schedule"}]}]},{"description":"Vaginal Ultrasound of Pregnant Uterus in 1st Trimester","code_information":[ { "code": "76817", "type": "CPT" } ],"standard_charges":[{"minimum":26.9000,"maximum":150.0000,"gross_charge":198.7300,"discounted_cash":198.7300,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":38.9700,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":65.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":66.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":47.2100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":61.5400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":26.9000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":50.0700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":67.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":49.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":46.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":33.0800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":46.1000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":35.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":46.3200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":45.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":54.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":61.2600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":61.2600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":38.9700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":59.6500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Cholesterol Level","code_information":[ { "code": "82465", "type": "CPT" } ],"standard_charges":[{"minimum":3.9500,"maximum":10.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.3700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.3500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.1400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":5.3700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.3500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.9500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.7300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":5.9200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.1400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.1200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.8400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":5.3700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.3500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":5.9700,"methodology":"fee schedule"}]}]},{"description":"MRI of Single Breast With and Without Contrast","code_information":[ { "code": "77048", "type": "CPT" } ],"standard_charges":[{"minimum":107.5400,"maximum":800.0000,"gross_charge":975.0000,"discounted_cash":975.0000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":107.5400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":513.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":202.0200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":286.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":141.4100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":289.5600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":543.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":362.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":202.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":232.9000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":133.0500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":164.3800,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":276.2500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":217.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":170.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":513.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":347.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":296.4900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":107.5400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Sodium Level in Urine Sample","code_information":[ { "code": "84300", "type": "CPT" } ],"standard_charges":[{"minimum":3.0600,"maximum":8.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.6000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.0600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.6400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.4700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.0600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.1400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.6300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.9800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.4000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.0600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":6.6200,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Heart Without Contrast","code_information":[ { "code": "75571", "type": "CPT" } ],"standard_charges":[{"minimum":26.1200,"maximum":400.0000,"gross_charge":711.9700,"discounted_cash":711.9700,"setting":"outpatient","payers_information":[{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":79.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":41.2500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":27.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":48.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":62.7100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - SGPT Enzyme Level","code_information":[ { "code": "84460", "type": "CPT" } ],"standard_charges":[{"minimum":5.0500,"maximum":16.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.5400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.0200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.3000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":5.0500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.5400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.3000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":5.0600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.7600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":7.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":5.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.7900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.8900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.5400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.3000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Protein Level in Blood","code_information":[ { "code": "84165", "type": "CPT" } ],"standard_charges":[{"minimum":11.6100,"maximum":40.0000,"gross_charge":71.4000,"discounted_cash":71.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":14.3500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.6800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":14.1600,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":32.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":12.8300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.2100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.3200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.3500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.3500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.0800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":13.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"MRI of Abdomen Without Contrast","code_information":[ { "code": "74181", "type": "CPT" } ],"standard_charges":[{"minimum":75.0700,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":193.3700,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":75.0700,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":242.0400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":152.9900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":89.1400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":144.7400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":237.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":190.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":102.3500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":108.9900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":115.8400,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":198.0800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":108.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":214.6000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":214.6000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":75.0700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":154.9600,"methodology":"fee schedule"}]}]},{"description":"Nuclear Medicine Study of Bones And\/or Joints in Whole Body","code_information":[ { "code": "78306", "type": "CPT" } ],"standard_charges":[{"minimum":68.2800,"maximum":278.7600,"gross_charge":656.9900,"discounted_cash":656.9900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":119.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":119.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":99.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":162.7400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":161.1600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":82.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":71.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":163.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":263.5600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":186.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":68.2800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":272.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":107.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":139.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":278.7600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":278.7600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":269.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Progesterone Hormone Level","code_information":[ { "code": "84144", "type": "CPT" } ],"standard_charges":[{"minimum":18.9600,"maximum":65.0000,"gross_charge":163.6200,"discounted_cash":163.6200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":36.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":33.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":62.9200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":20.8600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":19.8900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":58.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":20.8600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":18.9600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.6700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":28.4200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":19.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":24.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":30.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.1800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":20.8600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":52.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Examination of White Blood Cells Using Microscope","code_information":[ { "code": "85008", "type": "CPT" } ],"standard_charges":[{"minimum":2.5100,"maximum":17.0000,"gross_charge":12.0000,"discounted_cash":12.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.2400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":8.9300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.4300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.2800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":3.4300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":5.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":4.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.4300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":2.5100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":3.7300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":4.6800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":3.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":4.9700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":4.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":3.8200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.2400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.4300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":4.6800,"methodology":"fee schedule"}]}]},{"description":"MRI of Brain With Contrast","code_information":[ { "code": "70552", "type": "CPT" } ],"standard_charges":[{"minimum":91.6700,"maximum":800.0000,"gross_charge":1788.0900,"discounted_cash":1788.0900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":91.6700,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":254.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":221.2200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":97.9200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":224.0800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":543.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":360.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":258.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":193.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":107.5600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":138.4600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":323.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":131.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":218.1200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":137.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":237.0700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":237.0700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":91.6700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":224.0800,"methodology":"fee schedule"}]}]},{"description":"MRI of Arm With Contrast","code_information":[ { "code": "73219", "type": "CPT" } ],"standard_charges":[{"minimum":83.5500,"maximum":650.0000,"gross_charge":1502.6000,"discounted_cash":1502.6000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":83.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":265.6800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":189.4000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":173.3000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":200.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":297.0800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":209.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":130.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":154.8800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":600.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":160.5500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":214.5400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":158.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":200.6300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":200.6300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":83.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":193.1700,"methodology":"fee schedule"}]}]},{"description":"MRI of Arm With Contrast","code_information":[ { "code": "73222", "type": "CPT" } ],"standard_charges":[{"minimum":83.5500,"maximum":650.0000,"gross_charge":1502.6000,"discounted_cash":1502.6000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":83.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":265.6800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":189.4000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":173.3000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":200.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":297.0800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":209.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":130.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":154.8800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":600.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":160.5500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":214.5400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":158.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":200.6300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":200.6300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":83.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":193.1700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Electrolyte Panel","code_information":[ { "code": "80051", "type": "CPT" } ],"standard_charges":[{"minimum":6.3800,"maximum":40.0000,"gross_charge":39.7400,"discounted_cash":39.7400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.0100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.6900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.0100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":6.3800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.6200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.6900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.3200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":8.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.7900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.0100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"MRI of Abdomen With and Without Contrast","code_information":[ { "code": "74183", "type": "CPT" } ],"standard_charges":[{"minimum":112.9600,"maximum":1300.0000,"gross_charge":1502.6000,"discounted_cash":1502.6000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":112.9600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":306.9000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":284.1800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":136.6600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":218.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":335.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":290.6300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":155.3700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":176.3900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":175.2000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":239.8200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":173.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":325.1600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":325.1600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":112.9600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":287.7400,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels of Heart With Contrast","code_information":[ { "code": "75574", "type": "CPT" } ],"standard_charges":[{"minimum":41.2500,"maximum":494.0000,"gross_charge":805.2700,"discounted_cash":805.2700,"setting":"outpatient","payers_information":[{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":179.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":41.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":106.6900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":142.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":127.6300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":142.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":494.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":254.4700,"methodology":"fee schedule"}]}]},{"description":"External Ultrasound of Pregnant Uterus in 1st Trimester","code_information":[ { "code": "76801", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":150.0000,"gross_charge":45.0000,"discounted_cash":45.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":51.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":53.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":54.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":53.8200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":75.9600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":41.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":31.6600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":63.6200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":38.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":54.7900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":44.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":44.8900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":58.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":50.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":76.1200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":76.1200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":51.2500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":74.2000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Cortisol Hormone Level","code_information":[ { "code": "82533", "type": "CPT" } ],"standard_charges":[{"minimum":14.8200,"maximum":45.0000,"gross_charge":285.0000,"discounted_cash":285.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":20.1200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":43.9200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.3000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":15.5500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":20.1200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":16.3000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":14.8200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":17.7100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":22.2100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":15.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":26.6800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":23.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":18.1100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":20.1200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.3000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":22.3600,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Knee, 4 or More Views","code_information":[ { "code": "73564", "type": "CPT" } ],"standard_charges":[{"minimum":8.7500,"maximum":35.8700,"gross_charge":46.0000,"discounted_cash":46.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":21.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.9300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":35.8700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":19.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":13.0300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":20.2600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":13.2900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.3900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":35.3900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":14.1900,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":17.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":20.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":33.1000,"methodology":"fee schedule"}]}]},{"description":"Ultrasound of Chest","code_information":[ { "code": "76604", "type": "CPT" } ],"standard_charges":[{"minimum":15.0000,"maximum":150.0000,"gross_charge":176.8300,"discounted_cash":176.8300,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":27.7900,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":45.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":42.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":38.2800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":40.0900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":33.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":26.0800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":48.9400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":44.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":30.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":35.5000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":32.1700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":29.0400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":39.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":36.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":64.1600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":64.1600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":27.7900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":51.2900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total T3 Thyroid Hormone Level","code_information":[ { "code": "84480", "type": "CPT" } ],"standard_charges":[{"minimum":12.8900,"maximum":48.0000,"gross_charge":28.9100,"discounted_cash":28.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":25.4000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":24.7000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":24.2700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.5100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":47.3300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.1800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":13.5200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":17.5100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":14.1800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.8900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.4100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":25.4000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":19.3100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.5200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.6600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":20.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":17.5100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.1800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Soft Tissue of the Neck With Contrast","code_information":[ { "code": "70491", "type": "CPT" } ],"standard_charges":[{"minimum":67.8200,"maximum":450.0000,"gross_charge":730.4200,"discounted_cash":730.4200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":71.1000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":187.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":142.3900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":137.8700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":67.8200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":103.9700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":142.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":151.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":122.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":73.2800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":93.1300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":83.2200,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":118.5100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":92.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":137.0200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":137.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":71.1000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":136.0500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Calculation of Creatinine Clearance","code_information":[ { "code": "82575", "type": "CPT" } ],"standard_charges":[{"minimum":8.5900,"maximum":23.7500,"gross_charge":25.0000,"discounted_cash":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":10.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":23.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.4600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.6700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.4600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":8.5900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":10.2800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":12.8800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":10.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":10.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.5100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":11.6700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.4600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":12.9700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Bilirubin Level","code_information":[ { "code": "82247", "type": "CPT" } ],"standard_charges":[{"minimum":4.2000,"maximum":24.0000,"gross_charge":70.2100,"discounted_cash":70.2100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.1900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.0200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.7800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.1900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":21.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.4500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.8300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.1000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.5700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":6.8300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Pelvis, 3 or More Views","code_information":[ { "code": "72190", "type": "CPT" } ],"standard_charges":[{"minimum":3.2000,"maximum":33.8000,"gross_charge":66.2800,"discounted_cash":66.2800,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.1900,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":21.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":21.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":30.2400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":3.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":17.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":12.3100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":19.3500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":21.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":18.6000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":33.8000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.5600,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.6200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":17.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":27.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":19.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":27.5500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":27.5500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.1900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":28.3700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of CD4 and CD8 White Blood T Cells With Ratio","code_information":[ { "code": "86360", "type": "CPT" } ],"standard_charges":[{"minimum":9.5200,"maximum":136.8300,"gross_charge":267.7500,"discounted_cash":267.7500,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":46.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":58.0100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":136.8300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":46.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":58.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":123.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":76.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":68.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":46.9800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":42.7100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":51.0400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":65.6500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":64.0100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":44.8100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":76.1500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":55.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":37.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":45.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":52.2000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":58.0100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":46.9800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":9.5200,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Leg Without Contrast","code_information":[ { "code": "73700", "type": "CPT" } ],"standard_charges":[{"minimum":49.5600,"maximum":450.0000,"gross_charge":703.4000,"discounted_cash":703.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":51.6100,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":195.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":119.9700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":93.9000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":49.5600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":92.0800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":57.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":69.7000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":66.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":106.8500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":72.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":51.6100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":106.9500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Abdomen, 2 Views","code_information":[ { "code": "74019", "type": "CPT" } ],"standard_charges":[{"minimum":6.3000,"maximum":31.4500,"gross_charge":98.7700,"discounted_cash":98.7700,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":6.3000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.9100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":17.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.3700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":17.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":23.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":11.2400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":11.1500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.4800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":11.9000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":31.4500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.9100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":26.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":18.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.1100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.1100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.9100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.7300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ribs on Both Sides, 3 or More Views","code_information":[ { "code": "71110", "type": "CPT" } ],"standard_charges":[{"minimum":10.0000,"maximum":33.8100,"gross_charge":127.8000,"discounted_cash":127.8000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.1600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":28.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":17.7900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":30.5900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":24.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":12.7700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":20.4300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":14.1300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":13.0700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.8800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":33.8100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":14.3100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.9600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":18.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.7300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":25.7300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":15.1600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":28.7300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Thyroglobulin Hormone Level","code_information":[ { "code": "84432", "type": "CPT" } ],"standard_charges":[{"minimum":18.2500,"maximum":157.5000,"gross_charge":57.1200,"discounted_cash":57.1200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":32.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":24.4000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":21.9100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.3300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.9100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":20.1600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":21.9100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":82.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":157.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":21.9100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":18.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":21.9100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":20.1600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":23.5100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":20.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":24.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":23.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.9100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":21.9100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.9100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Paranasal Sinuses, 1-2 Views","code_information":[ { "code": "70210", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":26.5300,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":18.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.7000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.2600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.4600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.1900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.9600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.2600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.6400,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.0700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":16.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.3800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":21.3800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":22.5500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Elbow, 3 or More Views","code_information":[ { "code": "73080", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":27.7600,"gross_charge":98.7700,"discounted_cash":98.7700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.3200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.2600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.6400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.9800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.4900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.2600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":27.7600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.2700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.0300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":16.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":22.5500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Single Hip, 1 View","code_information":[ { "code": "73501", "type": "CPT" } ],"standard_charges":[{"minimum":5.0000,"maximum":26.5800,"gross_charge":60.9200,"discounted_cash":60.9200,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":15.7600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.2000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.3700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.7700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.4200,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":26.5800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.7700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.0200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":21.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":22.5500,"methodology":"fee schedule"}]}]},{"description":"Nuclear Medicine Scan of Thyroid","code_information":[ { "code": "78013", "type": "CPT" } ],"standard_charges":[{"minimum":57.5000,"maximum":185.2300,"gross_charge":299.9900,"discounted_cash":299.9900,"setting":"outpatient","payers_information":[{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":68.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":107.7800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":101.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":72.9000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":72.9000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":58.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":58.6700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":119.2700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":178.8700,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":155.5200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":57.8000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":90.8100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":57.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":182.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":68.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":93.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":185.2300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":185.2300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":181.1400,"methodology":"fee schedule"}]}]},{"description":"Ultrasound of Pelvic Cavity Via Rectum","code_information":[ { "code": "76872", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":150.0000,"gross_charge":165.5200,"discounted_cash":165.5200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":34.2900,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":65.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":57.3200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":110.0800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":38.7600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":49.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":65.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":42.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":57.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":49.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":46.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":32.5100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":56.5600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":34.8300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":45.6800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":55.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":63.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":64.8800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":64.8800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":34.2900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":113.1300,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels in Head With Contrast","code_information":[ { "code": "70496", "type": "CPT" } ],"standard_charges":[{"minimum":68.7500,"maximum":450.0000,"gross_charge":668.6400,"discounted_cash":668.6400,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":89.8600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":146.5400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":180.0700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":243.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":87.3400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":149.9500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":247.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":155.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":98.4400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":127.0400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":120.0100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":127.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":210.2500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":210.2500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":89.8600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":183.7000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Esophagus With Single Contrast Agent","code_information":[ { "code": "74220", "type": "CPT" } ],"standard_charges":[{"minimum":14.3500,"maximum":78.5600,"gross_charge":158.9800,"discounted_cash":158.9800,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":14.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":34.6500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":37.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":37.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":31.2800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":73.8500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":34.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":26.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":26.9700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":45.2300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":37.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":23.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":27.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":29.5900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":44.2100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":78.5600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":31.6700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":44.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":49.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":40.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":66.7000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":66.7000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":34.6500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":67.6600,"methodology":"fee schedule"}]}]},{"description":"MRI of Upper Spinal Canal With and Without Contrast","code_information":[ { "code": "72156", "type": "CPT" } ],"standard_charges":[{"minimum":116.7400,"maximum":1300.0000,"gross_charge":1788.0900,"discounted_cash":1788.0900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":302.4800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":255.3400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":116.7400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":194.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":545.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":362.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":284.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":193.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":127.7700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":166.7900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":323.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":155.9100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":242.8900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":166.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":272.6000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":272.6000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":258.2700,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels in Neck With Contrast","code_information":[ { "code": "70498", "type": "CPT" } ],"standard_charges":[{"minimum":68.7500,"maximum":450.0000,"gross_charge":1448.3100,"discounted_cash":1448.3100,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":89.8600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":212.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":229.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":165.4300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":180.0700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":98.9600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":183.7000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":155.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":98.2000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":145.0200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":119.7200,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":146.5400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":229.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":169.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":209.5200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":209.5200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":89.8600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":183.7000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Protein Level in Body Fluid Other Than Blood","code_information":[ { "code": "84166", "type": "CPT" } ],"standard_charges":[{"minimum":15.5300,"maximum":50.0000,"gross_charge":270.0000,"discounted_cash":270.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":42.9700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.6200,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":22.0100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":17.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":48.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":43.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":17.8300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":15.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.3700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":24.9200,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.2900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":25.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":20.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":33.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":27.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.0100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.8300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.2700,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ribs on Both Sides and Chest, 4 or More Views","code_information":[ { "code": "71111", "type": "CPT" } ],"standard_charges":[{"minimum":12.2500,"maximum":43.2000,"gross_charge":55.0000,"discounted_cash":55.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":12.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.9600,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":29.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":29.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":20.6600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":37.9800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":28.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":15.5800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":24.0400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.9200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":15.9900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.3100,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":43.2000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":16.8500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":17.2300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":22.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":33.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":21.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":31.1700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":31.1700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.9600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":35.6400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Neck, 4 or 5 Views","code_information":[ { "code": "72050", "type": "CPT" } ],"standard_charges":[{"minimum":11.2500,"maximum":40.6900,"gross_charge":118.6400,"discounted_cash":118.6400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.2400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":11.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":19.3700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":40.4400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":22.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":15.1300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":23.1400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":29.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":15.2300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.8400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":40.6900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":16.2100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":11.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":17.1900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":22.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":25.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":30.0800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":30.0800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.2400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":37.4600,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Mid Spine Without Contrast","code_information":[ { "code": "72128", "type": "CPT" } ],"standard_charges":[{"minimum":49.6800,"maximum":450.0000,"gross_charge":805.2700,"discounted_cash":805.2700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":51.6100,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":195.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":119.9700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":94.2500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":49.6800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":92.4400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":57.4300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":69.7600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":66.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":107.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":72.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":51.6100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":107.6700,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Pelvis Without Contrast","code_information":[ { "code": "72192", "type": "CPT" } ],"standard_charges":[{"minimum":45.9700,"maximum":450.0000,"gross_charge":703.4000,"discounted_cash":703.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":55.9400,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":195.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":117.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":93.5500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":45.9700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":74.6600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":114.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":49.2400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":68.0900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":59.7600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":106.3700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":68.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":93.5200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":93.5200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":55.9400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":92.7600,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Shoulder, 1 View","code_information":[ { "code": "73020", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":20.5900,"gross_charge":69.6100,"discounted_cash":69.6100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.3000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":14.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":15.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":8.9800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.4100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":13.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.8700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":7.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":10.5500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":20.5900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":8.2300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.4900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":12.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.2200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":15.2200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.3000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":13.8200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of CD4 White Blood T Cells","code_information":[ { "code": "86361", "type": "CPT" } ],"standard_charges":[{"minimum":5.7100,"maximum":108.0000,"gross_charge":624.7500,"discounted_cash":624.7500,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":41.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":33.0600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":71.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":25.5300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":26.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":108.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":108.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":86.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":26.7800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":24.3400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":29.0900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":25.5300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":39.1800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":31.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":37.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":34.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":33.0600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":26.7800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":5.7100,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels of Leg With Contrast","code_information":[ { "code": "73706", "type": "CPT" } ],"standard_charges":[{"minimum":93.2100,"maximum":450.0000,"gross_charge":676.7000,"discounted_cash":676.7000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":96.7100,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":149.7900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":180.0600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":243.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":93.2100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":181.9900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":247.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":170.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":170.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":117.0100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":135.0600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":140.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":132.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":96.7100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":183.7000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Both Hips, 3-4 Views","code_information":[ { "code": "73522", "type": "CPT" } ],"standard_charges":[{"minimum":12.7100,"maximum":43.6600,"gross_charge":170.2000,"discounted_cash":170.2000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.5200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":25.5400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":40.0900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":15.7900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":24.9600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":29.1100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.7100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":17.4800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.4100,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":43.6600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":17.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":22.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":23.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":34.4300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":34.4300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":15.5200,"methodology":"fee schedule"}]}]},{"description":"Single Nuclear Medicine Study To Evaluate Blood Ejection From The Heart During Specific Phases of Heart Cycle","code_information":[ { "code": "78472", "type": "CPT" } ],"standard_charges":[{"minimum":75.7400,"maximum":250.0000,"gross_charge":890.8300,"discounted_cash":890.8300,"setting":"outpatient","payers_information":[{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":166.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":118.7500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":164.5300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":121.4400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":118.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":95.6200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":124.7700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":185.0300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":227.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":75.7400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":189.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":156.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":182.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":193.5700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":186.9600,"methodology":"fee schedule"}]}]},{"description":"Nuclear Medicine Study To Locate Tumor or Infection With Whole Body Imaging Completed In a Single Day","code_information":[ { "code": "78802", "type": "CPT" } ],"standard_charges":[{"minimum":61.2500,"maximum":301.2300,"gross_charge":3816.1500,"discounted_cash":3816.1500,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":61.2500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":123.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":226.0300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":171.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":109.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":107.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":194.3500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":282.9900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":254.0600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":271.0900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":86.5400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":294.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":140.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":157.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":301.2300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":301.2300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":285.1700,"methodology":"fee schedule"}]}]},{"description":"MRI of Arm Without Contrast","code_information":[ { "code": "73218", "type": "CPT" } ],"standard_charges":[{"minimum":69.8400,"maximum":650.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":193.3700,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":69.8400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":245.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":132.2100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":84.8100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":154.9100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":468.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":238.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":178.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":94.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":116.6400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":600.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":109.4700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":196.9500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":113.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":140.0400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":140.0400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":69.8400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":134.8300,"methodology":"fee schedule"}]}]},{"description":"MRI of Arm Without Contrast","code_information":[ { "code": "73221", "type": "CPT" } ],"standard_charges":[{"minimum":69.8400,"maximum":650.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":193.3700,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":69.8400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":245.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":132.2100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":84.8100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":154.9100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":468.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":238.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":178.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":94.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":116.6400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":600.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":109.4700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":196.9500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":113.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":140.0400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":140.0400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":69.8400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":134.8300,"methodology":"fee schedule"}]}]},{"description":"MRI of Leg Not Including Joint With Contrast","code_information":[ { "code": "73719", "type": "CPT" } ],"standard_charges":[{"minimum":83.3700,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":83.3700,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":253.2900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":224.0300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":105.7900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":175.3500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":335.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":271.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":121.8800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":135.7300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":135.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":216.3300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":83.3700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":228.0800,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Abdomen Without Contrast","code_information":[ { "code": "74150", "type": "CPT" } ],"standard_charges":[{"minimum":47.2600,"maximum":450.0000,"gross_charge":703.4000,"discounted_cash":703.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":61.3500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":195.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":117.9700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":47.2600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":76.7400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":114.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":50.5500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":71.1500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":61.3500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":107.3700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":71.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":92.0700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":92.0700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":61.3500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":91.3000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Protein C Blood Clotting Inhibitor Activity","code_information":[ { "code": "85303", "type": "CPT" } ],"standard_charges":[{"minimum":12.5800,"maximum":180.0000,"gross_charge":518.5400,"discounted_cash":518.5400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":107.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":82.8300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.0800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":42.5800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.8400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":13.1900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":17.0800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":135.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.8400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.5800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.0300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":18.8400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":51.4100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":107.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":65.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.3700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":17.0800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.8400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":180.0000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Head or Brain With and Without Contrast","code_information":[ { "code": "70470", "type": "CPT" } ],"standard_charges":[{"minimum":60.1800,"maximum":650.0000,"gross_charge":824.5500,"discounted_cash":824.5500,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":65.3200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":245.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":148.1700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":130.8300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":60.1800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":98.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":151.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":122.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":64.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":87.3100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":78.4500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":111.8600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":86.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":130.8600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":130.8600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":65.3200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":130.2300,"methodology":"fee schedule"}]}]},{"description":"MRI of Middle Spinal Canal Without Contrast","code_information":[ { "code": "72146", "type": "CPT" } ],"standard_charges":[{"minimum":69.1200,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":193.3700,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":76.5100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":238.1100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":69.1200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":115.3700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":238.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":75.7400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":100.5700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":317.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":92.3400,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":199.6000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":100.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":154.4300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":154.4300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":76.5100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":145.5100,"methodology":"fee schedule"}]}]},{"description":"Nuclear Medicine Study of Liver and Bile Ducts","code_information":[ { "code": "78227", "type": "CPT" } ],"standard_charges":[{"minimum":95.0000,"maximum":431.0000,"gross_charge":795.2700,"discounted_cash":795.2700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":190.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":204.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":149.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":190.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":226.7400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":238.3600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":156.7700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":156.7800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":172.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":190.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":113.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":111.9500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":278.2400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":407.2600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":173.8200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":271.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":168.0600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":420.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":204.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":200.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":431.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":431.0000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":414.6700,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Soft Tissue of the Neck With and Without Contrast","code_information":[ { "code": "70492", "type": "CPT" } ],"standard_charges":[{"minimum":68.7500,"maximum":450.0000,"gross_charge":824.5500,"discounted_cash":824.5500,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":83.0100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":190.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":157.1600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":168.8200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":80.7700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":125.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":87.2300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":111.5800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":100.3000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":128.7600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":110.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":167.4800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":167.4800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":83.0100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":166.6100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Glucose Level Following Sugar Intake","code_information":[ { "code": "82950", "type": "CPT" } ],"standard_charges":[{"minimum":6.0800,"maximum":30.6700,"gross_charge":69.6100,"discounted_cash":69.6100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":10.4000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":11.1700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.2000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.8700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.4600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.0800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":8.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":11.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.6700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.4600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.1000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.4000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":10.1600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.8000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.3600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":8.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.2800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":9.2000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.4600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":30.6700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Glucose Level Following Sugar Intake","code_information":[ { "code": "82951", "type": "CPT" } ],"standard_charges":[{"minimum":6.0800,"maximum":30.6700,"gross_charge":69.6100,"discounted_cash":69.6100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":10.4000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":11.1700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.2000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.8700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.4600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":6.0800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":8.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":11.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.6700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.4600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.1000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":10.4000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":10.1600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.8000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":6.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.3600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":8.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.2800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":9.2000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.4600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":30.6700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factor X Using Diluted Russell Viper Venom","code_information":[ { "code": "85613", "type": "CPT" } ],"standard_charges":[{"minimum":5.5500,"maximum":88.0000,"gross_charge":173.8500,"discounted_cash":173.8500,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":13.3700,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":13.3700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":11.2600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":13.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":13.1600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":11.8800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.3700,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.2600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.5500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":13.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":88.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Fingers","code_information":[ { "code": "73140", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":31.3000,"gross_charge":58.1900,"discounted_cash":58.1900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.2200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":13.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":13.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.2900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":31.3000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.2200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.4600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":12.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.8400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.1600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":27.8600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.5300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.7300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":25.7300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.2200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":29.1000,"methodology":"fee schedule"}]}]},{"description":"Limited or Follow-up Ultrasound of Abdomen","code_information":[ { "code": "76705", "type": "CPT" } ],"standard_charges":[{"minimum":28.7600,"maximum":150.0000,"gross_charge":132.4400,"discounted_cash":132.4400,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":29.9500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":65.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":43.2100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":64.3600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":28.7600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":47.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":50.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":32.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":34.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":30.9900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":41.8300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":33.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":40.1100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":40.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":53.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":64.1600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":64.1600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":29.9500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":63.2900,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Soft Tissue of the Neck Without Contrast","code_information":[ { "code": "70490", "type": "CPT" } ],"standard_charges":[{"minimum":53.5200,"maximum":450.0000,"gross_charge":703.4000,"discounted_cash":703.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":65.6800,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":183.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":120.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":103.0500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":53.5200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":86.0500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":60.4900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":78.0400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":68.8800,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":109.7000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":77.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":106.2100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":106.2100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":65.6800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":102.2200,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Abdomen With Contrast","code_information":[ { "code": "74160", "type": "CPT" } ],"standard_charges":[{"minimum":65.3200,"maximum":450.0000,"gross_charge":805.2700,"discounted_cash":805.2700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":65.3200,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":148.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":180.0700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":74.4100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":118.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":142.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":142.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":77.4600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":105.9400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":94.5400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":121.8400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":102.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":171.1000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":171.1000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":65.3200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":183.7000,"methodology":"fee schedule"}]}]},{"description":"Ultrasound Evaluation of Fetal Viability With Non-Stress Test","code_information":[ { "code": "76818", "type": "CPT" } ],"standard_charges":[{"minimum":30.0000,"maximum":150.0000,"gross_charge":132.4400,"discounted_cash":132.4400,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":55.5700,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":62.2600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":67.8700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":37.4800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":63.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":67.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":42.0500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":59.0400,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":44.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":60.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":58.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":71.4000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":71.4000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":55.5700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":67.2900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Free Protein S Blood Clotting Inhibitor Level","code_information":[ { "code": "85306", "type": "CPT" } ],"standard_charges":[{"minimum":13.9300,"maximum":140.0000,"gross_charge":253.0000,"discounted_cash":253.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":24.1000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":43.5600,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":18.9200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":92.3300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":15.3200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":14.6200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":15.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":13.9300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.6500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":20.8800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":14.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":30.5100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":17.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":22.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":17.0300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":18.9200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":15.3200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":140.0000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Head or Brain With Contrast","code_information":[ { "code": "70460", "type": "CPT" } ],"standard_charges":[{"minimum":54.8000,"maximum":450.0000,"gross_charge":730.4200,"discounted_cash":730.4200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":58.4600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":187.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":135.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":108.6700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":55.9600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":83.5400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":151.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":122.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":54.8000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":75.0200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":66.8600,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":108.7300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":75.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":108.7500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":108.7500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":58.4600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":108.7600,"methodology":"fee schedule"}]}]},{"description":"MRI of Lower Spinal Canal With and Without Contrast","code_information":[ { "code": "72158", "type": "CPT" } ],"standard_charges":[{"minimum":116.5200,"maximum":1300.0000,"gross_charge":1788.0900,"discounted_cash":1788.0900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":302.3600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":254.6300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":116.5200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":194.4300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":545.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":362.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":284.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":193.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":127.4200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":166.5000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":323.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":155.6200,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":240.5200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":165.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":271.5100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":271.5100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":257.5400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Estrogen Hormone Level","code_information":[ { "code": "82672", "type": "CPT" } ],"standard_charges":[{"minimum":19.7200,"maximum":76.0000,"gross_charge":249.9000,"discounted_cash":249.9000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":34.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":26.7800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":73.6700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":20.6900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":26.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":19.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.5700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":29.5600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":20.6900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":38.0400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":25.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":37.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":31.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":24.1100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":26.7800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.7000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":76.0000,"methodology":"fee schedule"}]}]},{"description":"Nuclear Medicine Study of Stomach Emptying","code_information":[ { "code": "78264", "type": "CPT" } ],"standard_charges":[{"minimum":74.5000,"maximum":317.1800,"gross_charge":695.3100,"discounted_cash":695.3100,"setting":"outpatient","payers_information":[{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":82.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":82.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":90.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":82.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":187.4600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":178.3900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":77.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":204.7800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":300.9100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":82.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":267.8800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":74.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":189.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":79.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":310.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":103.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":133.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":317.1800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":317.1800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":306.2700,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Skull Bones, 1-3 Views","code_information":[ { "code": "70250", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":32.4200,"gross_charge":55.0000,"discounted_cash":55.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":20.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.1700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":27.4300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":18.7000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":11.3800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":23.6700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.2000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.5200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":32.4200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.0500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.9900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":27.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":25.8200,"methodology":"fee schedule"}]}]},{"description":"Nuclear Medicine Study of Thyroid by Measurement of Iodine Uptake","code_information":[ { "code": "78012", "type": "CPT" } ],"standard_charges":[{"minimum":29.0000,"maximum":85.0000,"gross_charge":262.2700,"discounted_cash":262.2700,"setting":"outpatient","payers_information":[{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":67.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":44.0600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":42.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":29.0300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":29.0400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":29.0400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":29.0400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":48.9500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":74.9400,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":63.7500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":42.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":70.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":75.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":76.1200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":76.1200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":74.9200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Glucose Level in Body Fluid Other Than Blood","code_information":[ { "code": "82945", "type": "CPT" } ],"standard_charges":[{"minimum":3.6600,"maximum":44.0000,"gross_charge":23.2000,"discounted_cash":23.2000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":5.4800,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":5.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.3800,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.8500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.6000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.7500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":3.9300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.9300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.2700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":5.4800,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":5.3500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.3100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":4.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.3700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.8500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.9300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":44.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Ionized Calcium Level","code_information":[ { "code": "82330", "type": "CPT" } ],"standard_charges":[{"minimum":9.0000,"maximum":52.0000,"gross_charge":70.0000,"discounted_cash":70.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":36.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":37.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.8800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":46.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.6800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":13.0400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.6800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.4300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.8600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":38.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":18.6300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.0400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.5100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":26.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.2000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":16.8800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.6800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":18.7600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Antithrombin III Blood Clotting Inhibitor Activity","code_information":[ { "code": "85300", "type": "CPT" } ],"standard_charges":[{"minimum":10.7800,"maximum":140.0000,"gross_charge":428.4000,"discounted_cash":428.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":60.7500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":49.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.6300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":60.3300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":11.8500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":74.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":57.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":12.9200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":74.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":74.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":11.8500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.7800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.8800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":64.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":16.1500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":28.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":60.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":38.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":13.1700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":14.6300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.8500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":140.0000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Arm Without Contrast","code_information":[ { "code": "73200", "type": "CPT" } ],"standard_charges":[{"minimum":50.6400,"maximum":450.0000,"gross_charge":703.4000,"discounted_cash":703.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":81.8100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":51.6100,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":195.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":119.9700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":109.7300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":50.6400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":91.9000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":151.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":122.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":57.2600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":73.5700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":66.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":106.8000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":72.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":51.6100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":113.1300,"methodology":"fee schedule"}]}]},{"description":"Whole Body Nuclear Medicine Study To Determine Spread of Thyroid Cancer","code_information":[ { "code": "78018", "type": "CPT" } ],"standard_charges":[{"minimum":90.0000,"maximum":400.0000,"gross_charge":1004.0000,"discounted_cash":1004.0000,"setting":"outpatient","payers_information":[{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":233.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":166.2500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":192.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":220.7200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":166.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":166.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":187.1900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":278.2600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":400.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":288.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":100.2000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":285.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":218.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":255.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":289.9900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":283.3500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Protein Level in Body Fluid Other Than Blood or Urine","code_information":[ { "code": "84157", "type": "CPT" } ],"standard_charges":[{"minimum":3.3400,"maximum":52.0000,"gross_charge":18.0000,"discounted_cash":18.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":6.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":15.1900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.5300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":3.3400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.1500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":6.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.0700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":4.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":52.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Creatine Level","code_information":[ { "code": "82540", "type": "CPT" } ],"standard_charges":[{"minimum":4.9200,"maximum":45.0000,"gross_charge":58.1900,"discounted_cash":58.1900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":5.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":5.4100,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":5.7100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.4100,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.3200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.3200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.9200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":18.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":5.2700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.7500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":5.4100,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.3200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.9200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.3900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":6.3200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.3200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.3200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":6.3600,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Abdomen With and Without Contrast","code_information":[ { "code": "74170", "type": "CPT" } ],"standard_charges":[{"minimum":71.8200,"maximum":650.0000,"gross_charge":937.1200,"discounted_cash":937.1200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":71.8200,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":258.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.4700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":180.0700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":79.6700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":134.4200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":142.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":88.0500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":114.6600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":94.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":136.7600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":115.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":196.8400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":196.8400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":71.8200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":183.7000,"methodology":"fee schedule"}]}]},{"description":"MRI of Blood Vessels of Head Without Contrast","code_information":[ { "code": "70544", "type": "CPT" } ],"standard_charges":[{"minimum":61.7100,"maximum":800.0000,"gross_charge":1456.9100,"discounted_cash":1456.9100,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":61.7100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":142.0800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":186.4000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":87.6100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":189.1500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":260.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":195.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":112.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":114.0800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":118.3300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":115.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":246.8600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":246.8600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":61.7100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":189.1500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Eye, Ear, or Sella Turcica Without Contrast","code_information":[ { "code": "70480", "type": "CPT" } ],"standard_charges":[{"minimum":53.5500,"maximum":450.0000,"gross_charge":703.4000,"discounted_cash":703.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":53.5500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":65.6800,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":183.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":122.3800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":109.7300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":55.3600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":119.2200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":68.0800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":81.8600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":72.3600,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":111.3700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":81.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":119.6200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":65.6800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":113.1300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Mid\/Lower Back Junction","code_information":[ { "code": "72080", "type": "CPT" } ],"standard_charges":[{"minimum":7.7000,"maximum":29.0000,"gross_charge":98.7700,"discounted_cash":98.7700,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.7000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":20.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.1400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.9600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":18.7000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.2600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":17.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.8100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.8300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":27.4000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":12.0300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.0500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":27.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":18.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.8300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.8300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":23.6400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ribs one On Side and Chest, 3 or More Views","code_information":[ { "code": "71101", "type": "CPT" } ],"standard_charges":[{"minimum":12.2300,"maximum":32.8100,"gross_charge":44.0000,"discounted_cash":44.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.0700,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":17.4900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":29.8900,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":19.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":12.2300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":19.5200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":26.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.5800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":18.8900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":32.8100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.6800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.2300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":16.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.0100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":25.0100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.0700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"}]}]},{"description":"MRI of Lower Spinal Canal With Contrast","code_information":[ { "code": "72149", "type": "CPT" } ],"standard_charges":[{"minimum":92.0300,"maximum":800.0000,"gross_charge":1788.0900,"discounted_cash":1788.0900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":223.1300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":92.0300,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":254.3700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":223.3300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":98.3800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":165.1600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":545.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":362.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":310.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":193.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":108.0800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":139.1500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":132.1800,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":218.1200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":138.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":238.5200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":238.5200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":92.0300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":225.8900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ribs on One Side, 2 Views","code_information":[ { "code": "71100", "type": "CPT" } ],"standard_charges":[{"minimum":7.7500,"maximum":29.5500,"gross_charge":108.6400,"discounted_cash":108.6400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":20.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.1700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.6500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.3700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":17.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":18.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":10.7700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.9900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":11.1200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.3600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":29.5500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":11.9100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.9400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":24.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.4700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.5500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.7300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Pituitary Hormone Level","code_information":[ { "code": "82024", "type": "CPT" } ],"standard_charges":[{"minimum":35.1100,"maximum":160.0000,"gross_charge":327.1300,"discounted_cash":327.1300,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":160.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":82.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":47.6800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":104.6700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":38.6200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":96.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":36.8300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":47.6800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":38.6200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":35.1100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":41.9600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":52.6100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":36.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":69.5500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":45.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":91.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":70.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":42.9100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":47.6800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":38.6200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":116.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Aldosterone Hormone Level","code_information":[ { "code": "82088", "type": "CPT" } ],"standard_charges":[{"minimum":37.2100,"maximum":146.0000,"gross_charge":304.0400,"discounted_cash":304.0400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":62.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":122.6300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":129.2100,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":50.3100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":118.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":40.7500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":38.8600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":50.3100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":146.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":146.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":40.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":37.2100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":44.2700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":145.2600,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":55.5100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":38.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":74.8200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":47.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":135.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":94.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":45.2800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":50.3100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":40.7500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":72.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Soft Tissue of The Neck","code_information":[ { "code": "70360", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":24.9900,"gross_charge":118.6400,"discounted_cash":118.6400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":14.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.0700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.2100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":13.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.9400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.4700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":12.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.4400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.8700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.9900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.1300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.0700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":19.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":11.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.2900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":20.2900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":21.8200,"methodology":"fee schedule"}]}]},{"description":"MRI of Blood Vessels of Head With Contrast","code_information":[ { "code": "70545", "type": "CPT" } ],"standard_charges":[{"minimum":61.7100,"maximum":800.0000,"gross_charge":1727.9900,"discounted_cash":1727.9900,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":61.7100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":141.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":199.4100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":101.2600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":200.4300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":289.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":232.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":115.2100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":116.8700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":126.4500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":114.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":254.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":61.7100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":200.4300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Paranasal Sinuses, 3 or More Views","code_information":[ { "code": "70220", "type": "CPT" } ],"standard_charges":[{"minimum":10.0000,"maximum":33.7000,"gross_charge":118.6400,"discounted_cash":118.6400,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":17.4300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":27.7800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":11.6000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":19.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.8600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":17.4100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":33.7000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.4300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":17.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.3700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":25.3700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":25.8200,"methodology":"fee schedule"}]}]},{"description":"MRI of Pelvis Without Contrast","code_information":[ { "code": "72195", "type": "CPT" } ],"standard_charges":[{"minimum":75.0700,"maximum":800.0000,"gross_charge":1371.2100,"discounted_cash":1371.2100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":75.0700,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":246.5200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":193.7800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":92.9300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":162.3300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":260.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":195.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":112.1600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":121.6600,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":123.5200,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":198.1200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":117.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":385.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":246.8700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":246.8700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":75.0700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":196.7900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Toes","code_information":[ { "code": "73660", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":24.7900,"gross_charge":69.6100,"discounted_cash":69.6100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":13.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":13.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.8300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.2100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.9400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.4700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.4100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.6500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.7900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.1400,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.4800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":12.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.1100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.1100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":21.8200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Collarbone","code_information":[ { "code": "73000", "type": "CPT" } ],"standard_charges":[{"minimum":4.2000,"maximum":24.6400,"gross_charge":69.6100,"discounted_cash":69.6100,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":15.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":15.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.6100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.2000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.2900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.7100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.6400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.3900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":21.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":23.2700,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Facial Bones With Contrast","code_information":[ { "code": "70487", "type": "CPT" } ],"standard_charges":[{"minimum":52.7100,"maximum":450.0000,"gross_charge":730.4200,"discounted_cash":730.4200,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":89.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":57.7400,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":187.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":136.3500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":113.6000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":52.7100,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":85.7100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":142.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":151.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":122.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":56.3700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":76.4500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":68.6000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":119.4500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":76.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":113.8200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":113.8200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":57.7400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":112.7700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - General Health Panel","code_information":[ { "code": "80050", "type": "CPT" } ],"standard_charges":[{"minimum":10.0700,"maximum":90.0000,"gross_charge":75.0000,"discounted_cash":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":11.6700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":49.4000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":54.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":54.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":43.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Estriol Hormone Level","code_information":[ { "code": "82677", "type": "CPT" } ],"standard_charges":[{"minimum":21.9800,"maximum":72.0000,"gross_charge":89.2500,"discounted_cash":89.2500,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":39.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":36.4300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":29.8500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":57.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.1800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":23.0600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":29.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":24.1800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":21.9800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.2700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":39.6500,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":32.9400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":23.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":37.3200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":28.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":37.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":33.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.8700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":29.8500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":24.1800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":72.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Urea Nitrogen Level in Urine","code_information":[ { "code": "84540", "type": "CPT" } ],"standard_charges":[{"minimum":3.7300,"maximum":12.7300,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":4.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":4.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.8600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.7300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.5600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":3.9000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":5.8600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.5600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.0900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.6400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.5300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.4000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":3.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":4.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.5600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":5.8600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.5600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":6.4600,"methodology":"fee schedule"}]}]},{"description":"MRI of Middle Spinal Canal With and Without Contrast","code_information":[ { "code": "72157", "type": "CPT" } ],"standard_charges":[{"minimum":116.9500,"maximum":1300.0000,"gross_charge":1788.0900,"discounted_cash":1788.0900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":302.6600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":256.0400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":116.9500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":195.1600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":545.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":362.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":284.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":193.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":128.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":167.0500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":323.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":156.2000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":235.8500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":166.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":273.3200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":273.3200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":259.0000,"methodology":"fee schedule"}]}]},{"description":"MRI of Face or Neck With and Without Contrast","code_information":[ { "code": "70543", "type": "CPT" } ],"standard_charges":[{"minimum":109.7100,"maximum":1300.0000,"gross_charge":1502.6000,"discounted_cash":1502.6000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":109.7100,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":306.4200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":285.9300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":134.3600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":288.4700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":517.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":345.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":335.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":290.6300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":137.4500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":173.1800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":165.6400,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":238.5900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":171.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":304.5000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":304.5000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":109.7100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":288.4700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factor VIII Deficiency","code_information":[ { "code": "85240", "type": "CPT" } ],"standard_charges":[{"minimum":16.2700,"maximum":125.0000,"gross_charge":141.1300,"discounted_cash":141.1300,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":123.4900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":119.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":122.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":22.1000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":69.8300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.9000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":115.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":21.9500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":22.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":112.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":17.9000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":16.2700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":123.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.3900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":17.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":43.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":115.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":71.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.8900,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":22.1000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.9000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":24.3700,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Both Knees with Standing Views","code_information":[ { "code": "73565", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":33.0500,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0300,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.9800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":33.0500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":13.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.3300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":11.9500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.8800,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":31.7000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":12.8000,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.4900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":19.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":15.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":27.5500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":27.5500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":30.5500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels of Abdomen With Contrast","code_information":[ { "code": "74175", "type": "CPT" } ],"standard_charges":[{"minimum":89.5800,"maximum":450.0000,"gross_charge":676.7000,"discounted_cash":676.7000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":92.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":147.9900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":179.7200,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":243.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":89.5800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":157.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":247.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":161.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":103.1400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":129.8500,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":110.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":129.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":221.8500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":221.8500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":92.7500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":183.7000,"methodology":"fee schedule"}]}]},{"description":"Nuclear Medicine Study of Parathyroid Gland","code_information":[ { "code": "78070", "type": "CPT" } ],"standard_charges":[{"minimum":41.8400,"maximum":278.7600,"gross_charge":774.2100,"discounted_cash":774.2100,"setting":"outpatient","payers_information":[{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":71.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":95.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":71.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":71.5000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":78.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":71.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":126.0400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":159.3600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":57.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":55.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":62.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":179.8500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":263.1200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":71.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":235.0900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":52.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":132.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":41.8400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":272.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":89.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":116.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":278.7600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":278.7600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":268.4400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Upper Leg, 1 View","code_information":[ { "code": "73551", "type": "CPT" } ],"standard_charges":[{"minimum":8.5000,"maximum":28.8000,"gross_charge":60.9200,"discounted_cash":60.9200,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.4900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.9000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.2900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.3000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.3000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.0700,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.9400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":18.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6600,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":21.0900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Phenytoin Level","code_information":[ { "code": "80185", "type": "CPT" } ],"standard_charges":[{"minimum":12.0500,"maximum":41.2500,"gross_charge":93.2900,"discounted_cash":93.2900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.3600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.2500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":12.6400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":16.3600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":12.0500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.4000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":18.0600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":12.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":14.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":14.7300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":16.3600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.2500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Tailbone","code_information":[ { "code": "72220", "type": "CPT" } ],"standard_charges":[{"minimum":6.3000,"maximum":24.9900,"gross_charge":78.8900,"discounted_cash":78.8900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":6.3000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":7.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":17.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.5900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.2600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":9.3500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.4600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.4400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.0300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.9900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":10.1300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":7.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.6600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":13.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":22.9100,"methodology":"fee schedule"}]}]},{"description":"Nuclear Medicine Study of Lymph Nodes","code_information":[ { "code": "78195", "type": "CPT" } ],"standard_charges":[{"minimum":52.5000,"maximum":317.9000,"gross_charge":435.6500,"discounted_cash":435.6500,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":52.5000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":116.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":96.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":211.3700,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":181.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":205.1300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":303.6400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":268.1900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":262.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":87.3700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":312.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":109.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":141.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":317.9000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":317.9000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":309.1800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Heel","code_information":[ { "code": "73650", "type": "CPT" } ],"standard_charges":[{"minimum":6.2500,"maximum":25.0000,"gross_charge":58.1900,"discounted_cash":58.1900,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.3000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":6.2500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":15.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.9900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.4500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":13.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":19.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":13.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":9.0800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.7100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":24.0200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":6.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.5200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":13.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.5700,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":19.5700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.3000,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.3600,"methodology":"fee schedule"}]}]},{"description":"MRI of Leg Joint With Contrast","code_information":[ { "code": "73722", "type": "CPT" } ],"standard_charges":[{"minimum":83.7300,"maximum":800.0000,"gross_charge":1502.6000,"discounted_cash":1502.6000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":83.7300,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":264.0500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":288.4000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":357.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":433.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":115.6900,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":195.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":431.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":310.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":232.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":127.7300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":157.9200,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":156.7100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":214.6200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":155.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":365.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":308.1300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":308.1300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":83.7300,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":290.6500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Alkaline Phosphatase Level","code_information":[ { "code": "84075", "type": "CPT" } ],"standard_charges":[{"minimum":4.3000,"maximum":20.0000,"gross_charge":15.0000,"discounted_cash":15.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.3900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.1800,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":4.9400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.3900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.1800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.3000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.6300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":4.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.2100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":6.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.7500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.3900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.1800,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Complete Nuclear Medicine Study of Kidney With Drug Administration","code_information":[ { "code": "78708", "type": "CPT" } ],"standard_charges":[{"minimum":57.8300,"maximum":191.0000,"gross_charge":560.0000,"discounted_cash":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":173.5000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":114.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":57.8300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":191.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":170.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":115.1500,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":92.7600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":116.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":155.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":138.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":80.6500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":123.5700,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":173.5000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":105.3700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":173.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":70.1800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":123.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":130.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":80.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":125.0400,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":125.0400,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":123.2900,"methodology":"fee schedule"}]}]},{"description":"SPECT Scan To Locate Tumor or Infection","code_information":[ { "code": "78803", "type": "CPT" } ],"standard_charges":[{"minimum":51.3300,"maximum":350.2900,"gross_charge":3816.1500,"discounted_cash":3816.1500,"setting":"outpatient","payers_information":[{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":83.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":248.9300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":181.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":131.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":139.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":247.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":220.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":200.1300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":316.9900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":261.1300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":95.1400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":302.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":101.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":66.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":310.6500,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":310.6500,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":350.2900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Abdomen, 3 or More Views","code_information":[ { "code": "74021", "type": "CPT" } ],"standard_charges":[{"minimum":8.7500,"maximum":33.7300,"gross_charge":84.7200,"discounted_cash":84.7200,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.0700,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":20.4600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":30.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":12.6200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":20.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":13.0500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.2800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":13.9200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.2100,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":33.7300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":13.9300,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":29.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":20.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.7300,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":25.7300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.0700,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":28.7300,"methodology":"fee schedule"}]}]},{"description":"Limited or Follow-Up Ultrasound of Female Pelvis Unrelated to Pregnancy","code_information":[ { "code": "76857", "type": "CPT" } ],"standard_charges":[{"minimum":15.4800,"maximum":150.0000,"gross_charge":88.0600,"discounted_cash":88.0600,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":25.6200,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":40.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":34.5300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.9600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":27.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":63.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":15.4800,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":24.9200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":36.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":16.4900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":24.8400,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":17.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":32.3000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":25.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":27.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":25.6200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":25.3100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Screening for Sickle Cell Anemia","code_information":[ { "code": "85660", "type": "CPT" } ],"standard_charges":[{"minimum":3.0000,"maximum":16.0000,"gross_charge":35.1000,"discounted_cash":35.1000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.8000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.5100,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":5.2600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":6.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.5100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":4.5500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.9900,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":7.5100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":5.2600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.4300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":5.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":6.1200,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":6.8000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.5100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Leg With Contrast","code_information":[ { "code": "73701", "type": "CPT" } ],"standard_charges":[{"minimum":59.9100,"maximum":450.0000,"gross_charge":748.9800,"discounted_cash":748.9800,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":67.5400,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":59.9100,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":204.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":146.3300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":128.3700,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":64.6600,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":115.6100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":142.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":151.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":122.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":75.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":90.7000,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":92.5300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":116.6400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":96.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":172.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":171.4600,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":171.4600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":59.9100,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":138.5900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Mid Back, 3 Views","code_information":[ { "code": "72072", "type": "CPT" } ],"standard_charges":[{"minimum":11.1900,"maximum":30.7800,"gross_charge":45.0000,"discounted_cash":45.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.1900,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":21.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.0300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":28.8300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":18.7000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":21.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":17.7200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":11.6000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":17.1300,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":30.7800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":12.4200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.7400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":27.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":19.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.1900,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":27.2800,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Facial Bones With and Without Contrast","code_information":[ { "code": "70488", "type": "CPT" } ],"standard_charges":[{"minimum":64.0400,"maximum":650.0000,"gross_charge":703.4000,"discounted_cash":703.4000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":65.3200,"methodology":"fee schedule"},{"payer_name":"Auxilio Salud Plus","plan_name":"Auxilio Salud Plus Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Bella Vista","plan_name":"Bella Vista Commercial","standard_charge_dollar":191.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":245.8300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":150.2800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":144.5500,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":151.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":216.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Health Maintenance Organization","standard_charge_dollar":64.0400,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":104.5400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":213.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":142.5000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":151.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":122.5000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Health Maintenance Organization","standard_charge_dollar":68.6700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":91.9100,"methodology":"fee schedule"},{"payer_name":"Nagico Insurance","plan_name":"Nagico Insurance Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"NHI","plan_name":"NHI Commercial","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Health Maintenance Organization","standard_charge_dollar":83.6700,"methodology":"fee schedule"},{"payer_name":"Plan Socios Auxilio","plan_name":"Plan Socios Auxilio Commercial","standard_charge_dollar":68.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":130.4700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":91.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":206.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Health Maintenance Organization","standard_charge_dollar":158.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":143.9100,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":143.9100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":65.3200,"methodology":"fee schedule"},{"payer_name":"Virgin Islands Medicaid","plan_name":"Virgin Islands Medicaid Commercial","standard_charge_dollar":142.9600,"methodology":"fee schedule"}]}]},{"description":"Diagnostic Exam of Esophagus, Stomach and Small Bowel Using Endoscope Inserted Through Mouth","code_information":[ { "code": "43235", "type": "CPT" } ],"standard_charges":[{"gross_charge":940.1000,"discounted_cash":940.1000,"setting":"outpatient"}]},{"description":"Exam of Entire Large Intestine with Biopsy Using Colonoscope","code_information":[ { "code": "45380", "type": "CPT" } ],"standard_charges":[{"gross_charge":315.8200,"discounted_cash":315.8200,"setting":"outpatient"}]},{"description":"Exam of Esophagus, Stomach, and Upper Small Intestine with Biopsy Using Endoscope Inserted Through Mouth","code_information":[ { "code": "43239", "type": "CPT" } ],"standard_charges":[{"gross_charge":315.8200,"discounted_cash":315.8200,"setting":"outpatient"}]},{"description":"Removal of Growth from Large Intestine By Snare Using Colonoscope","code_information":[ { "code": "45385", "type": "CPT" } ],"standard_charges":[{"gross_charge":315.8200,"discounted_cash":315.8200,"setting":"outpatient"}]},{"description":"X-Ray of Aorta and Both Leg Arteries With Catheter Insertion","code_information":[ { "code": "75630", "type": "CPT" } ],"standard_charges":[{"gross_charge":1200.0000,"discounted_cash":1200.0000,"setting":"outpatient"}]},{"description":"Exam of Entire Large Intestine Using Colonoscope","code_information":[ { "code": "G0121", "type": "HCPCS" } ],"standard_charges":[{"minimum":72.7300,"maximum":200.0000,"gross_charge":234.4300,"discounted_cash":234.4300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":72.7300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":200.0000,"methodology":"fee schedule"}]}]},{"description":"Exam of Entire Large Intestine Using Colonoscope","code_information":[ { "code": "G0105", "type": "HCPCS" } ],"standard_charges":[{"minimum":72.7300,"maximum":200.0000,"gross_charge":234.4300,"discounted_cash":234.4300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":72.7300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care Florida","plan_name":"United Health Care Florida Commercial","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":200.0000,"methodology":"fee schedule"}]}]}]}